University of Florida Vets Treat Horses with Life-Threatening Bleeding from Guttural Pouch

Two horses at risk for life-threatening bleeding caused by an uncommon infection of the internal carotid artery were successfully treated recently by University of Florida veterinarians who used cutting-edge technology to resolve the problem faster and less invasively than traditional surgery would allow.

"The problem both of these horses had involved a disease called guttural pouch mycosis, or a fungal infection in the guttural pouch," said Herb Maisenbacher, VMD, an assistant clinical professor of cardiology at UF's Veterinary Medical Center. "The infection can eat its way through the tissues in the back of the throat, potentially rupturing the arteries."

Typical symptoms include bleeding from the nose, Maisenbacher said.
UF veterinarians treated the first horse in October of 2008, and the second in May of 2009.

"One horse's red blood cell count was actually dropping because of the bleeding," he said. "The other had just one nose bleed. The owners knew they needed to do something before it became life-threatening."

Lynne Kimball-Davis of Wellington recalled the late October morning during which she went to feed her horse, a Dutch Warmblood named Upper Class, and discovered him in his stall bleeding profusely from the nose.

"It looked like he had been massacred," she said.

Kimball-Davis rushed her horse to Palm Beach Equine Clinic, where veterinarians determined a referral to UF was necessary.

"He was stabilized for two days and then Sunday morning, we got him up to Dr. (David) Freeman," Kimball-Davis said.

She added that Upper Class returned home after about a week at UF, and has made steady progress since then.

"I'm getting ready to show him in the fall again," she said. "Everyone has told me he's perfectly fine now and not to give his problem a second thought."

Freeman, MVB, PhD, Dipl. ACVS, a surgeon, collaborated with Maisenbacher's cardiology team to treat both cases. In each case, a device known as a vascular plug was inserted to occlude the at-risk artery. Before that, surgeons access the carotid artery through a small incision in the neck and use a contrast agent to find the damaged vessels before blocking them off.

"The affected area is difficult to approach surgically, but it's been done before," Maisenbacher said. "Another approach has been to place multiple metallic coils inside the vessel to block the flow of blood. What made our approach unique is that we were able to make the procedure go more smoothly by using newer devices to achieve the same result."

Freeman, who has used all the various techniques to treat vascular occlusion in horses with hemorrhage from guttural pouch mycosis, favors the new approach.

"The minimally invasive introduction of nitinol plugs seems the best to me," he said. "It's also a nice example of teamwork between the small and large animal hospitals that allows us to make use of leading edge technologies that benefit many species."

Maisenbacher said the vascular plugs are made for use in human medicine and are believed to have only been used at Purdue University's veterinary school to treat gutteral pouch mycosis in horses. Because of the success UF has had in treating dogs with the devices, Maisenbacher felt a similar result might be achieved in horses.

"Once the animals wake up from anesthesia, they are almost back to their normal selves," he said. "The other advantage is that the devices offer the ability to access vessels that by traditional methods are very difficult to get to. Plus, there really is no other medical treatment for this condition."

The procedure takes between two and three hours, he added.

Anyone seeking more information about UF's Veterinary Medical Center and treatments currently available for pets and horses should call 352/392-2213 or visit     

This report was written by Sarah Carey

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