Indwelling cephalic or saphenous vein catheter use for regional limb perfusion in 44 horses with synovial injury involving the distal aspect of the limb.
Authors: Kelmer Gal, Tatz Amos, Bdolah-Abram Tali
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Managing synovial contamination and infection in distal limb structures presents a significant clinical challenge, and regional limb perfusion offers a targeted approach to deliver high antibiotic concentrations directly to affected tissues. Kelmer and colleagues reviewed 44 horses (45 limbs) treated with indwelling intravenous regional limb perfusion (ID-IV-RLP) via either cephalic or saphenous vein catheters, documenting the frequency and impact of repeated perfusions over the treatment course. The study found that 87% of synovial infections resolved, with 61% of horses returning to soundness; amikacin was the most frequently administered antimicrobial agent, and horses typically received between 3 and 21 perfusions (median 7). Whilst catheter-related complications occurred in 27% of limbs—including potential thrombophlebitis and extravasation—these were not significantly correlated with clinical outcome; however, concurrent osteomyelitis emerged as a significant negative prognostic indicator. For practitioners, this work demonstrates that indwelling catheter placement represents a practical alternative to repeated venipuncture for successive regional perfusions, streamlining the treatment protocol for distal synovial injuries whilst achieving reasonable success rates, though careful patient selection and early detection of bone involvement remain critical to optimising outcomes.
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Practical Takeaways
- •Indwelling cephalic or saphenous vein catheters offer a practical alternative to traditional regional limb perfusion, allowing multiple antibiotic treatments without repeated needle placement
- •Expect successful synovial infection resolution in approximately 7 out of 8 cases, though soundness recovery is lower (~60%), and presence of bone involvement substantially worsens prognosis
- •Catheter complications occur in roughly 1 in 4 limbs but don't significantly impact treatment success—focus infection control efforts on ruling out osteomyelitis early
Key Findings
- •Synovial sepsis resolved in 87% of limbs (39/45) treated with indwelling regional limb perfusion via cephalic or saphenous vein catheter
- •61% of horses returned to soundness following treatment
- •Median of 7 perfusions per limb (range 3-21) were administered using indwelling catheters
- •Osteomyelitis presence was significantly associated with poor outcome; catheter-related complications (27%) were not