Ligation of the ipsilateral common carotid artery and topical treatment for the prevention of epistaxis from guttural pouch mycosis in horses.
Authors: Cousty M, Tricaud C, De Beauregard T, Picandet V, Bizon-Mercier C, Tessier C
Journal: The Veterinary record
Summary
# Editorial Summary: Carotid Ligation and Topical Treatment for Guttural Pouch Mycosis Guttural pouch mycosis remains a life-threatening condition in horses, with life-threatening haemorrhage occurring when fungal plaques erode into major blood vessels; this study evaluated whether ligating the ipsilateral common carotid artery combined with topical antimycotic therapy could prevent recurrent epistaxis in affected cases. Over a 10-year period, 24 horses underwent carotid ligation followed by various topical treatments administered either by spraying after membrane debridement (16 horses) or by direct intralesional injection via a transendoscopic needle (8 horses), with outcomes and recurrence rates documented. Epistaxis recurred in five horses (21%), with four cases proving fatal (17%), whilst the average number of topical treatments required was 6.3 (range 2–14) before resolution. Although carotid ligation offers a reasonable prognosis compared to untreated cases, the 17% mortality rate underscores the serious nature of this condition, and the technique appears particularly valuable where transarterial catheter occlusion is financially or technically unavailable; active removal of fungal plaques combined with topical medication may facilitate healing more effectively than medication alone. Practitioners should view this approach as a practical salvage procedure with fair but not guaranteed success, requiring realistic owner counselling regarding ongoing treatment commitment and persistent haemorrhage risk.
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Practical Takeaways
- •CCA ligation with topical antimycotic therapy is a reasonable salvage option when transarterial catheter occlusion is not financially or technically feasible, but carries meaningful mortality risk from rebleeding
- •Endoscopic mechanical debridement of the fungal membrane combined with topical treatment may improve outcomes and reduce treatment frequency
- •Expect multiple treatments (average 6) will likely be needed; clients should be counseled on the 16-20% risk of recurrent life-threatening epistaxis
Key Findings
- •Common carotid artery ligation combined with topical antimycotic treatment prevented recurrent epistaxis in 79.2% of cases (19/24 horses)
- •Fatal hemorrhage occurred in 16.6% of cases (4/24 horses) despite treatment
- •Mean of 6.3±4.0 topical treatments were required (range 2-14)
- •Mechanical removal of fungal plaque followed by topical treatment accelerated resolution of mycotic mucosal lesions