Ligation of the ipsilateral common carotid artery and topical treatment for the prevention of epistaxis from guttural pouch mycosis in horses.

The research paper examines how tying off the common carotid artery, combined with various antifungal treatments, could help to prevent nosebleeds in horses that have a fungal infection in their guttural pouch. The researchers found that this treatment has a decent success rate, although fatal bleeding can still occur.

Techniques and Methodology

• The study focused on investigating the impact of combining ligation of the common carotid artery (CCA) – a procedure that involves tying off the artery – with different types of antimycotic or antifungal treatments to prevent epistaxis, which are nosebleeds in horses suffering from guttural pouch mycosis – a fungal infection in the guttural pouch of the horse.
• The CCA ligation was performed on the same side (ipsilateral) as the guttural pouch mycosis, and was then followed by the application of a range of topical medications, guided by endoscopy.
• The researchers recorded the frequency and number of treatments, the outcome, and recurrence of haemorrhage for each case.

Results and Findings

• A total of 24 horses were included in the study. Depending on the case, the topical medication was administered either by detaching the diphtheric membrane and then spraying (16 cases) or through direct intradermal injection into the plaques using a transendoscopic needle (8 cases).
• The research team found that nosebleeds resumed in five horses, which is 20.8% of the subjects, leading to the death of four horses, or 16.6% of the total.
• On average, all the topical treatments required 6.3 treatments, with a range between 2 and 14.
• The study concluded that by combining ligation of the ipsilateral CCA with the use of topical medicines, there was a reasonable likelihood of preventing the recurrence of epistaxis, but there is also a risk of fatal haemorrhage.

Potential Enhancements

• Removing the fungal plaque and topically treating the underlying lesion seemed to accelerate the resolution of mycotic mucosal lesions – the lumpy or uneven patches of skin caused by the fungal infection.
• Financial or technical constraints may limit the usage of transarterial catheter occlusion techniques. In these cases, the technique proposed by this study could be used as a salvage procedure.