Destructive lesions of the proximal sesamoid bones as a complication of dorsal metatarsal artery catheterization in three horses.
Authors: Barr Elizabeth D, Clegg Peter D, Mark Senior J, Singer Ellen R
Journal: Veterinary surgery : VS
Summary
# Destructive Proximal Sesamoid Bone Lesions: A Rare But Serious Complication of Arterial Catheterization Direct arterial blood pressure monitoring via dorsal metatarsal artery catheterization is a valuable anaesthetic technique, but this case series from 2005 documented a previously underrecognised complication: focal osteolytic lesions of the proximal sesamoid bones (PSBs) in the fetlock region. Three client-owned horses developed severe lameness localised to the catheterised limb within three weeks of surgery; diagnostic imaging, ultrasonography, and arthroscopic examination confirmed destructive bone lesions, with evidence of infection suggesting bacterial seeding during or after catheter placement. Outcome varied considerably: one horse survived following surgical debridement of necrotic bone, whilst two others with inaccessible lesions failed medical management and were euthanatised, highlighting the grave prognostic implications of this complication. The authors identified inadequate aseptic technique, contaminated tubing, and non-sterile heparinised saline as likely culprits, and elimination of the problem through protocol changes—improved sterile technique, new manometer tubing, and fresh heparinised saline for each catheter—suggests this complication is preventable rather than inevitable. For practitioners involved in equine anaesthesia, this case series underscores the critical importance of meticulous aseptic discipline during arterial catheterisation and reinforces that even routine monitoring procedures carry genuine risks to limb integrity if sterile protocol is compromised.
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Practical Takeaways
- •Dorsal metatarsal artery catheterization for blood pressure monitoring carries risk of serious, potentially career-ending proximal sesamoid bone infection and destruction—consider risk-benefit carefully for routine monitoring
- •Strict aseptic technique during catheter insertion and maintenance is critical; any lameness in the catheterized limb within weeks post-anesthesia warrants immediate investigation including radiography and ultrasonography of the fetlock
- •Early recognition and aggressive treatment (including possible surgical debridement) offers the only chance for survival; however, many cases will be inaccessible to surgical intervention and fatal
Key Findings
- •Three horses developed severe lameness localized to the fetlock within 21 days following dorsal metatarsal artery catheterization for intraoperative blood pressure monitoring
- •Destructive lesions of proximal sesamoid bones were identified as a complication of arterial catheterization, with two cases proving inaccessible to surgical treatment
- •Surgical debridement was successful in one horse, while two horses with inaccessible lesions failed medical management and were euthanatized
- •Implementation of improved aseptic technique and protocol changes (new tubing, heparinized saline) eliminated this complication in subsequent procedures