Balloon catheter occlusion of the maxillary, internal, and external carotid arteries in standing horses.
Authors: Genton Martin, Farfan Maëlle, Tesson Camille, Laclaire Anne-Louise, Rossignol Fabrice, Mespoulhes-Rivière Céline
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Balloon Catheter Arterial Occlusion in Standing Horses Haemorrhage from guttural pouch mycosis represents a life-threatening emergency in equine practice, traditionally managed through general anaesthesia and surgical intervention; this 2021 study evaluated whether selective arterial occlusion using balloon catheters could be safely performed in standing, sedated horses as a viable alternative. Researchers conducted a two-phase investigation: phase 1 established the technique in eight healthy horses (four receiving bilateral internal carotid artery [ICA] occlusions; four receiving external carotid artery [ECA] and maxillary artery [MA] occlusions), whilst phase 2 applied the method clinically in 11 affected cases requiring ICA (n=7), ECA (n=2), or combined ICA/ECA (n=2) occlusion. Success rates were high, with ICA occlusion achieved in 14 of 17 arteries across both phases (mean procedure time 50–53 minutes), ECA occlusion successful in all 11 arteries (26–31 minutes), and MA occlusion in five of seven arteries attempted (47 minutes average). For practitioners managing haemorrhagic guttural pouch mycosis cases—particularly in geriatric, compromised, or systemically ill horses where general anaesthesia carries prohibitive risk—this standing procedure offers a genuine alternative that avoids recumbency whilst maintaining efficacy; however, success with maxillary artery occlusion appears less reliable, and referral to centres equipped for interventional radiology remains necessary.
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Practical Takeaways
- •Balloon catheter arterial occlusion offers a viable alternative to surgery and general anesthesia for managing guttural pouch mycosis hemorrhage in high-risk horses
- •Internal and external carotid artery occlusions are highly reliable (82-100% success), with external carotid being faster (26-31 min) and simpler than internal carotid procedures
- •This technique should be considered for horses where anesthesia risk is elevated due to age, systemic disease, or comorbidities
Key Findings
- •Internal carotid artery occlusion successful in 14 of 17 arteries (82%) across both phases with mean procedure duration of 51-53 minutes
- •External carotid artery occlusion successful in 11 of 11 arteries (100%) with mean procedure duration of 26-31 minutes
- •Maxillary artery occlusion successful in 5 of 7 arteries (71%) with mean catheter insertion distance of 42.8 cm
- •Balloon catheter occlusion is feasible in standing horses under sedation and local anesthesia, avoiding general anesthesia risks