33rd Annual Scientific Meeting proceedings

Surgical management is the treatment of choice for guttural pouch mycosis (GPM) associated to hemorrhage. Two surgical techniques, trans-arterial coil embolization (TACE) and balloon catheter occlusion (BCO) performed in standing horses, have been described to stop or prevent bleeding from the internal, external carotid artery or maxillary artery.^1,2  

General anesthesia (GA) in horses with previous hemorrhage related to GPM  presents an increased risk for fatal perianesthetic complications and the use of surgical techniques performed in standing horses may be advantageous.

TACE requires the use of angiography under fluoroscopy and is generally considered superior to BCO. It allows better identification of anatomical variations o aberrant branches of the ICA.

Ligation of the ipsilateral common carotid artery is a common practice in horse presenting moderate to severe epistaxis before TACE or BCA is performed.

Complications related to TACE and BCA in the standing horse are similar to those observed under GA, however, surgeons should be aware about possible patient collapse during TACE. Deep sedation and contrast product administration seem to be related to patient collapse.

Topical treatment as antifungal, oxygen or salpingopharyngeal fistula are acceptable treatments for GPM non associated to hemorrhage or as adjunctive treatment after TACE or BCA is performed.^{3, 4, 5} Dysphagia particularly can be severe enough to necessitate euthanasia even in the face of successful hemorrhage management.

References

1. Lepage OM, Piccot-Crézollet C. Transarterial coil embolisation in 31 horses (1999-2002) with guttural pouch mycosis: a 2-year follow-up. Equine Vet J. 2010;37(5):430-434.
2. Genton M, Farfan M,Camille Tesson C, Laclaire L, Rossignol F,Mespoulhes-Rivière C.Balloon catheter occlusion of the maxillary, internal, and external carotid arteries in standing horses. Veterinary Surgery. 2021;50:546–555.
3. Whitehead AE, Whitty J, Scott M, L ́eguillette R. Reversible dysphagia secondary to guttural pouch mycosis in a gelding treated medically with voriconazole and surgically with carotid occlusion and esopha- gostomy.Can Vet J . 2018;59(2):165-170
4. Lepage OM,  Francesco PD , Moulin N, Gangl M, Texier G, Marchi  J and Cadoré JL. The Effect of Topical Oxygen Therapy in Horses Affected with Mycosis of the Guttural Pouch: An Experimental Pilot Study and a Case Series. Animals 2021, 11, 3329.
5. Watwins A, Parente EJ. Salpingopharyngeal fistula as a treatment for guttural pouch mycosis in seven horses Equine Vet J, 2018,50(6):781-786