Manual graphic roadmap for transarterial coil embolization of guttural pouch arteries in horses: A technical note.
Authors: Mählmann Kathrin, Lischer Christophorus J
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Manual Graphic Roadmap for Guttural Pouch Artery Embolization Guttural pouch haemorrhage remains a life-threatening emergency in equine practice, and transarterial coil embolization (TACE) has become the gold-standard intervention; however, real-time fluoroscopic guidance during catheter navigation can be technically challenging, particularly in centres without advanced roadmap technology. Mählmann and Lischer present a practical low-tech solution developed over twelve years at the Free University of Berlin: a manual graphic roadmap (MGR) created by tracing vascular anatomy from the initial angiogram onto transparent foil placed directly on the fluoroscopy monitor, which then guides subsequent catheter advancement and coil placement throughout the procedure. Using this technique across all their TACE cases, the authors demonstrated that continuous anatomical reference markedly reduced the need for repeated contrast injections—requiring them only to confirm final vessel occlusion—thereby minimizing radiation exposure and procedural time without compromising technical accuracy. For equine centres with limited access to digital roadmap technology, this method offers a cost-effective means of improving procedural confidence and efficiency during emergency guttural pouch haemorrhage management. The authors appropriately acknowledge that formal evaluation of contrast usage, radiation dosimetry, and procedural metrics under standardized conditions would strengthen the evidence base for wider adoption of this technique.
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Practical Takeaways
- •If your clinic lacks advanced fluoroscopic roadmap technology, a simple manual graphic roadmap using transparent foil and markers on the monitor can effectively guide catheter placement during guttural pouch artery embolization
- •This low-cost technique reduces contrast medium usage and radiation exposure while maintaining procedural safety and success
- •The method requires an assistant to trace vascular anatomy from the initial angiogram, making it practical for equine clinics with limited technical resources
Key Findings
- •Manual graphic roadmap (MGR) technique successfully provided continuous anatomical orientation during transarterial coil embolization without fluoroscopic roadmap technology
- •MGR-assisted procedures required contrast injections only to confirm vessel occlusion, reducing unnecessary imaging
- •Technique was feasible and applicable across all TACE procedures performed at the institution between 2012 and 2024