Transarterial coil embolization of the internal and external carotid and maxillary arteries for prevention of hemorrhage from guttural pouch mycosis in horses.
Authors: Lévéille R, Hardy J, Robertson J T, Willis A M, Beard W L, Weisbrode S E, Lepage O M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Guttural pouch mycosis presents one of equine practice's most challenging haemorrhage emergencies, with traditional surgical approaches carrying significant morbidity and mortality risks. This 2000 study evaluated transarterial coil embolization as a minimally invasive alternative, selectively occluding the internal carotid, external carotid, and maxillary arteries in 10 healthy horses and 4 clinically affected animals, with pathological evaluation at various timepoints (1 week to 3 months post-procedure). The technique proved remarkably effective: all target vessels achieved complete angiographic occlusion with appropriate thrombus formation, whilst the four mycotic horses experienced complete cessation of epistaxis and spontaneous resolution of mycotic plaques by day 60 without additional intervention. One case of iatrogenic laryngeal hemiplegia and one cerebral embolisation occurred, highlighting the importance of precise catheter placement and vascular anatomy knowledge, though no ocular complications were observed despite aggressive arterial occlusion. For practitioners managing guttural pouch mycosis, this evidence supports transarterial embolization as a rapid, effective method that allows haemorrhage control even during active bleeding and eliminates the need for invasive surgical intervention—a genuinely game-changing alternative to traditional approaches that warrant serious consideration in clinical decision-making.
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Practical Takeaways
- •Transarterial coil embolization is a viable interventional radiologic option for controlling life-threatening epistaxis from guttural pouch mycosis when medical management fails
- •The technique can be performed safely even during active bleeding, allowing identification and occlusion of all hemorrhage sources in a single procedure
- •Awareness of potential complications (laryngeal hemiplegia, cerebral emboli) is important; ophthalmic monitoring should continue post-procedure despite no observed complications in this series
Key Findings
- •Transarterial coil embolization successfully occluded the internal carotid, external carotid, and maxillary arteries in all 14 horses with no hemorrhagic recurrence in 4 affected horses
- •Angiography confirmed complete vessel occlusion with proper coil positioning in normal horses (n=10)
- •All mycotic plaques resolved by day 60 in affected horses without additional treatment
- •One case of iatrogenic laryngeal hemiplegia occurred; no ophthalmic complications were observed