Balloon catheter occlusion of the maxillary, internal, and external carotid arteries in standing horses

Guttural Pouch Mycosis: A Three-Step Therapeutic Approach

The temporary ligation of the common carotid artery is performed as an emergency aid in cases of guttural pouch mycosis. Its usefulness is put into perspective after an anatomical summary of arterial vascularization involving a guttural pouch. It helps to better understand the need for the cranial (cerebral) and caudal (cardiac) occlusion of an arterial rupture by embolization in order to achieve maximum success in preventing and treating an hemorrhage. Topical oxygen therapy used alone or in a multimodal approach with embolization surgery is performed to promote healing of the inflammatory and mycotic lesions observed when an individual is affected. In conclusion, this three-step therapeutic approach should enable the equine practitioner to better orient their decision tree when faced with this condition which, while rare, can be potentially fatal if poorly treated.

Standing surgery among equine board certified surgeons: Survey regarding current use and trends

BACKGROUND

Publications about equine standing surgery are flourishing, however, information regarding its use and prevalence among surgeons is still limited.

OBJECTIVES

To determine the current use and recent trends for equine standing surgery among board certified surgeons and to identify the main reasons and limitations for performing a procedure standing.

STUDY DESIGN

Cross-sectional survey.

METHODS

A 139-item questionnaire was sent by email to 733 large animal surgery Diplomates (ACVS and ECVS) from November 2020 to February 2021. The survey collected demographic information and general data regarding standing surgery before being divided into seven identical sections for each body system, involving 36 standing procedures.

RESULTS

The survey response rate was 29.7% (218/733). Most respondents (58.9%, 126/214) had performed standing surgery for <10 years regardless of length of time they were board certified (48.2% board certified <10 years and 51.8% >10 years). Most respondents (range: 50.0%-92.9%, mean 69.5%) changed from performing 14/36 surgeries under general anaesthesia (GA) to standing within the previous 10 years and had always performed 8/36 surgeries standing (51.6%-73.9%, mean 61.4%) regardless of board certification time. Surgeons board certified <10 years ago performed more often 3/36 listed procedures standing than those board certified >10 years ago (p < 0.05). Avoiding GA (179/218) and/or reducing procedure cost (111/218) were the two main reasons to perform standing surgeries whereas the horse's behaviour (183/218) and/or the patient size/age (94/218) were the two main limiting factors.

MAIN LIMITATIONS

Low response rate. Results biased towards the opinion of a subgroup of surgeons, those performing standing surgery. Some standing procedures were not included in the survey.

CONCLUSIONS

The use of standing surgery is well established among board certified surgeons and progressively increasing, especially in the last 10 years and among recent Diplomates. With increased training and awareness, more Diplomates may be encouraged towards performing standing surgeries.

Endoscopic Anatomy of the Equine Guttural Pouch: An Anatomic Observational Study

Guttural pouch endoscopy allows for both the visualization and treatment of many clinical problems in the equine retropharyngeal region. This area is extremely complex, and its description remains a real challenge for veterinary anatomists and practitioners. Six clinically normal equine cadavers were employed. Conventional dissections of guttural pouches without penetrating the guttural pouch membrane were first performed, and each adjacent structure was identified. Then, a guttural pouch endoscopic exam of the dissected heads was performed in order to correctly map each visible underlying anatomic structure identified in the previous dissection. This allowed us to: 1-identify each structure visible on endoscopic examination of the guttural pouch; 2-create a representative map of all the structures accurately identified via endoscopy; and 3-describe a systematic guttural pouch endoscopic examination with practical keys to help identification of the underlying vital structures. Our investigation provides new practical information on guttural pouch endoscopic anatomy and has allowed us to identify structures that were not previously described. We believe that this information may help with an accurate diagnosis in some cases and also potentially reduce iatrogenic trauma to important structures.

Laryngeal tie-forward in standing sedated horses

OBJECTIVES

To investigate the feasibility and describe the clinical experience of performing laryngeal tie-forward (LTF) in standing horses unaffected (experimental) and affected (clinical) by intermittent dorsal displacement of the soft palate (iDDSP).

STUDY DESIGN

Experimental study and case series.

ANIMALS

Five normal experimental controls and five client owned horses affected by iDDSP.

METHODS

Standing LTF was performed and evaluated in five experimental horses and five clinical cases diagnosed with iDDSP. Standing LTF was performed under endoscopic guidance with horses sedated and the surgical site desensitized with local anesthetic solution. Short term outcome was assessed using radiography, resting and (in clinical cases) dynamic upper respiratory tract (URT) endoscopy.

RESULTS

Standing LTF was well tolerated and completed in all horses. Radiographic assessment demonstrated that compared to preoperatively, the basihyoid bone and thyrohyoid-thyroid articulation were positioned dorsally (9.6 mm, p = .006 and 20.4 mm, p = .007, respectively) at 2 days postoperatively. During repeat dynamic URT endoscopy at 48 hours postoperatively, 3/5 horses showed resolution of iDDSP and 2/5 marked improvement. One horse experienced brief iDDSP associated with neck flexion which corrected after swallowing. The second achieved a greater speed and total distance prior to iDDSP.

CONCLUSIONS

Standing LTF did not incur any major peri- or postoperative complications. The laryngohyoid apparatus was repositioned dorsally and in a small case series had a similar surgical effect on laryngeal position.

CLINICAL SIGNIFICANCE

Standing LTF is feasible, mitigates the risk of general anesthesia related complications and reduces cost.