Access via major artery used in series of surgeries on horses – report

Percutaneous ultrasound-guided puncture to the right common carotid artery, with the horse under general anaesthesia.
Percutaneous ultrasound-guided puncture to the right common carotid artery, with the horse under general anaesthesia. Photo: Vitoria et al.

Ultrasound‐guided access through the carotid artery in horses for the treatment of several conditions, including guttural pouch mycosis, is both feasible and effective, researchers report.

Endovascular surgery is a type of image‐guided minimally invasive surgery that aims to solve different types of problems from inside the blood vessel. The technique requires access to a peripheral vein or artery, and the navigation through the vascular system to reach the operating site, using different catheters.

In horses, the greatest potential use for endovascular therapy centres around access to the common carotid artery for different purposes – in particular for the sealing off of vessels to treat fungal infections affecting the guttural pouch. Other potential uses include investigation of haematomas, diagnosis and treatment of blood vessel anomalies and aneurysms, dealing with accessible tumors and clot removal.

Traditionally, these are dealt with surgically through open dissection of the neck to reach and incise the common carotid artery, followed by vascular stitching of the vessel and skin closure when the procedure is over. However, some have been performed in experimental horses by accessing the artery through the skin using ultrasound to guide the needle to its adequate position in the artery.

In human medicine, commercial closure systems are used to seal these arterial punctures and avoid some complications, mainly hematomas and haemorrhages.

Arantza Vitoria and her fellow researchers, writing in the journal Animals, have described their experience in a series of 11 clinical cases in which this minimally invasive way of access was used, and the puncture site was sealed using the Angio-Seal arterial closure system, reporting its first use in horses.

Their study centered on 11 cases involving horses aged 1 to 17, and 12 uses of the technique (one case involved arterial access from both sides of the neck). In all cases, the common carotid artery was accessed while the horse was under anaesthesia and lying on its side.

The reasons for arterial access were seven guttural pouch artery embolisations (bilateral in one case), three diagnostic arteriographies (two ethmoidal haematomas and one horse with unexplained Horner’s syndrome) and two presurgical tumour embolisations. In the bilateral case, both accesses were performed 48 hours apart, starting on the right side.

“In all cases, the artery was effectively accessed, and the planned procedure could be performed,” the researchers reported.

They said there were two cases of haematoma/bleeding (a rate of 16.66%), which was lower than in other studies using the same type of access. In both cases, the bleeding was caused by incorrect use of the Angio-Seal device.

In all procedures, angiography could be successfully performed. The introducer sheath, guidewire and interventional catheter could be placed and used without difficulty. All manoeuvres with the blood vessel were possible.

The authors said the advantages of procedures are the minimally invasive approach with minimal tissue dissection, which should decrease the time required for tissue healing. It also reduces the risk of tissue infection, wound problems and nerve damage.

In one of the procedures, there was an issue, when the introducer punctured the jugular vein, most probably during vascular access. It remained sealed until the end of the otherwise uneventful operation, after which it required open surgery to correct.

Such complications are a reminder of one of the disadvantages of the procedure, the study team said: Its technical difficulty and the necessary experience and learning curve of the surgeon, as recognised in human medicine for similar interventions.

“Our experience in a clinical case series confirms previous experimental results, which showed that percutaneous ultrasound‐guided carotid access is feasible and effective in horses undergoing endovascular procedures, avoiding open arteriotomy,” they said.

“To seal the arterial puncture site, regardless of possible complications due to incorrect use, the Angio‐Seal human medicine device can be used safely and effectively in horses.

“However, further studies comparing arterial access site management using this device or using manual compression would be necessary to state if its routine use in horses is advisable.”

The study team comprised Vitoria, Alicia Laborda, Carolina Serrano-Casorrán, Sara Fuente, Antonio Romero and Francisco José Vázquez, all affiliated with the Veterinary Hospital of the University of Zaragoza in Spain, and the university’s Department of Animal Pathology, part of its veterinary faculty.

Vitoria, A.; Laborda, A.; Serrano-Casorrán, C.; Fuente, S.; Romero, A.; Vázquez, F.J. Percutaneous Ultrasound-Guided Carotid Access and Puncture Closure with Angio-Seal in Horses. Animals 2022, 12, 1481.

The study, published under a Creative Commons License, can be read here.

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