Embolization under fluoroscopy in horses

Incidence of vascular disorders is rare in equids, but when present they can be fatal. It is the case when we suspect rupture of a major artery in the guttural pouch. Once diagnosis of epistaxis originating from the guttural pouch is confirmed, and differential diagnosis has excluded fracture of the stylohyoid bone and rupture of thelongus capitusmuscle, surgical treatment should be initiated immediately because if left untreated the risk of fatal hemorrhage is always high. Surgical vascular occlusion for prevention of hemorrhage is the recommended procedure and knowledge of a trans-arterial coil embolization (TACE) technique under fluoroscopic guidance is presently the most helpful approach to resolve or prevent further epistaxis (Lepage and Piccot-Crezollet 2005). Other methods of vascular occlusion include, use of transarterial nitinol vascular plug device, use of detachable balloon, and insertion of a balloon-tipped venous thrombectomy catheter. In choosing an occlusion method, the surgeon must consider technical limitations, including access to a fluoroscope if a TACE procedure is selected, and possible complications for each of these options (Jenningset al.,2019).

Different approaches to perform a TACE procedure

General anesthesia in lateral recumbency The original TACE procedure, presented for the first time at the 1999 annual ECVS meeting, was under general anesthesia. After routine induction of anesthesia (Léveilléet al. 1999), horses are placed in lateral recumbency with the affected guttural pouch uppermost. The head and neck are positioned on a custom-made plexiglas table (Fig. 1), to enable fluoroscopy. An area over the jugular groove at the junction of the upper and middle third of the neck is prepared aseptically. All personnel need to wear shielding aprons during the procedure. [...]