Polyarthritis secondary to septic thrombophlebitis in an Arabian mare

A 3‐year‐old Arabian mare presented with diarrhoea and depression. During hospitalisation, the mare developed septic thrombophlebitis associated with a jugular catheter. One week later, she developed secondary bilateral tarsocrural joint septic arthritis. Following surgical intervention and intensive medical therapy, the mare recovered successfully. The case highlights an unusual and previously unreported complication of septic thrombophlebitis.     

Effects of Jugular Vein Occlusion on Cardiovascular Parameters in Horses During Exercise on a Treadmill

The purpose of the present investigation was to examine the effects of unilateral and bilateral jugular vein occlusion by temporary surgical ligature on the heart rate and arterial and venous blood pressure in sedentary horses during progressive treadmill exercise. Six horses performed three exercise tests (ET). ET1, considered the control, was performed in horses without jugular occlusions. ET2 and ET3 were performed with unilateral and bilateral occlusion by temporary surgical ligature of the jugular veins, respectively. Heart rate, arterial pressure, and pressure of the occluded jugular vein were evaluated. Clinically, the horses presented apathy, head edema, congested mucous membranes, increased capillary refill time, and dysphagia. These signs were observed with the unilateral jugular vein occlusion and became more evident with the bilateral occlusion. Comparing ETs, no differences were observed in heart rate. However, jugular occlusions promoted a decrease in the mean arterial pressure and a severe increase in jugular pressure. Head edema caused by the jugular vein occlusion in the horses could interfere with the autonomic cardiovascular regulation of arterial blood pressure during exercise, likely leading to an impairment of tissue perfusion. Jugular occlusion, even unilateral, also causes severe head venous congestion, leading to venous hypertension that was aggravated by exercise, which could risk development of cerebral edema and neurological damage. The present results obtained from sedentary horses are preliminary data that lead us to suggest that sport horses presenting jugular occlusive thrombophlebitis, even unilateral, may be prevented from performing athletic activities.     

Partial aneurysmectomy and autologous patch venoplasty in a horse diagnosed with pseudoaneurysm of the jugular vein

Experience with vascular pathology and vascular surgery, especially with the use of grafts, is limited in horses. Only one case of a venous aneurysm has been described in the horse, but without successful surgical correction. This case report describes the treatment of a 3-year-old female pony presented with an intermittent localised swelling of the left jugular vein after a previous thrombophlebitis. Ultrasonographic examination revealed a large jugular vein pseudoaneurysm. Treatment consisted of a partial aneurysmectomy preserving the healthy medial wall of the jugular vein. An autologous saphenous vein patch technique was used to reconstruct the vein with the largest possible lumen to minimise thrombus formation. Anticoagulants, antimicrobial and anti-inflammatory drugs were administered pre- and post-operatively. Follow-up ultrasound examinations initially showed local narrowing of the graft. At 2 and 8 months post-operatively, no external deformation of the jugular vein was visible and ultrasonography revealed patent blood flow with only a slight difference in lumen diameter. The patch venoplasty proved a viable surgical technique for jugular vein reconstruction resulting in a sufficient lumen, no thrombus formation and a good cosmetic and functional outcome.     

A Reproducible Venous Thrombosis Model in Horses Induced by the Combination of an Endothelial Lesion and Blood Flow Stasis

Because of the high incidence of thromboembolic diseases in humans, experimental models of thrombosis have been widely developed in different animal species. The pathogenesis of thrombosis is associated with three components, first outlined by Virchow in 1856: vessel injury, stasis, and hypercoagulability. Based on this concept, the purpose of the present investigation was to create an innovative model of jugular thrombophlebitis in horses that included components of Virchow's triad and excluded surgical procedures. Eighteen horses were subjected to blood vessel injury through the coadministration of sclerosing agents (glucose and ethanolamine oleate) and transitory occlusion of the jugular flow by manual compression. Thrombus formation was followed by ultrasonography imaging, and all horses developed jugular thrombophlebitis, showing that the proposed model was effective. Once occlusive thrombophlebitis was induced, jugular venous pressure cranial to the lesion was evaluated and yielded increased values, suggesting cephalic hypertension. Biochemical tests were performed to verify hepatotoxicity and nephrotoxicity after the ethanolamine injection, but no abnormalities were observed. Five horses were then euthanized to evaluate the vascular, hepatic, and renal tissues. The jugular vein wall had increased thickness, inflammatory cell influx, endothelial destruction, and thrombus firmly adhered to the vessel intima. Histological evaluation of the hepatic and renal tissues was normal. The present thrombophlebitis model in the jugular vein of the horse is simple and reproducible, providing a useful tool for investigating acute and chronic venous thrombosis because the model allows evaluation of different aspects of the prevention, pathogenesis, and treatment of this disease.     

Pulmonary embolism as a complication after abdominal surgery and colitis in a foal

This report describes a fatal pulmonary embolism in a foal, as a sequela of septic thrombophlebitis of the right jugular vein and/or a generalised hypercoagulable state. The foal underwent abdominal surgery and suffered from severe and prolonged colitis. Despite intense supportive care, the colt developed venous thrombophlebitis and subsequently died suddenly 12 days after discharge from the hospital, following an initial improvement. On post‐mortem examination, a large pulmonary embolism was discovered. Pulmonary thromboembolism is a potentially fatal sequelae of thrombus formation. It is difficult to detect and therefore likely to be underdiagnosed.     

Evaluation of risk factors for development of catheter-associated jugular thrombophlebitis in horses: 50 cases (1993-1998)

OBJECTIVE: To evaluate risk factors associated with development of catheter-associated jugular thrombophlebitis in hospitalized horses. DESIGN: Retrospective case-control study. ANIMALS: 50 horses with thrombophlebitis and 100 control horses. PROCEDURE: Medical records from 1993 through 1998 were searched for horses with thrombophlebitis. Horses that were hospitalized for at least 5 days, had an i.v. catheter placed in a jugular vein (other than for solely anesthetic purposes), and had no evidence of thrombophlebitis during admission or hospitalization were chosen as controls. Signalment, history, clinicopathologic findings, primary illness, and treatment were obtained from the medical records. Data were analyzed by use of logistic regression to perform univariate and multivariate analyses. RESULTS: For a horse with endotoxemia, the odds of developing thrombophlebitis were 18 times those for a similar horse without endotoxemia. For a horse with salmonellosis, the odds of developing thrombophlebitis were 68 times those for a similar horse without salmonellosis. For a horse with hypoproteinemia, the odds of developing thrombophlebitis were almost 5 times those for a similar horse without hypoproteinemia. For a horse in the medicine section, the odds of developing thrombophlebitis were 16 times those for a similar horse in the surgery section. For a horse with large intestinal dise, the odds of developing thrombophlebitis were 4 times those for a similar horse without large intestinal disease. For a horse receiving antidiarrheal or antiulcerative medications, the odds of developing thrombophlebitis were 31 times those for a similar horse not receiving these medications. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that patient factors, including large intestinal disease, hypoproteinemia, salmonellosis, and endotoxemia, were associated with development of catheter-associated thrombophlebitis in horses.     

Effects of 5% and 10% Guaifenesin Infusion on Equine Vascular Endothelium

Twelve horses of various breeds and either sex were anesthetized with xylazine and ketamine injected into a median or lateral thoracic vein. During anesthesia, with the horse in sternal recumbency, a 14-gauge, 8.9 cm catheter was inserted into each jugular vein by using aseptic technique. Guaifenesin in water (100 mg/kg or a maximum dose of 50 grams) was infused into one jugular vein and an equal volume of 0.9% saline solution was infused into the other jugular vein. Seven horses received 10% guaifenesin, and five horses received 5% guaifenesin. The catheters were removed before the horses recovered from anesthesia. The horses were euthanatized approximately 48 hours later, and the jugular veins were removed for histologic examination. Adherent thrombus material was observed in all veins exposed to 10% guaifenesin and in one vein exposed to 5% guaifenesin. No evidence of thrombus was observed in four veins infused with 5% guaifenesin or in those infused with saline solution. These findings are of particular significance with horses at increased risk for thrombosis or thrombophlebitis.     

Factors influencing the development of jugular thrombophlebitis in cattle and comparison of 2 types of catheter

Two studies were conducted to evaluate the factors associated with the development of thrombophlebitis in cattle following intravenous catheterization of the jugular vein. In study 1, 20 healthy animals were catheterized with 2 different types of catheter (polytetrafluoroethylene (PTE) versus polyvinylchloride (PVC)) for a period of 120 hours. In study 2, 50 dairy cows referred for treatment to the Large Animal Veterinary Teaching Hospital at the University of Montreal were catheterized with a commercial PTE catheter, using a standardized technique, for a period varying from 3 to 6 days, and inherent risk factors were evaluated. A clinical and echographical evaluation of the 2 groups in study 1 demonstrated a higher frequency of thrombosis in the PTE group than in the PVC group. In study 2, the primary factors associated with the development of thrombophlebitis in sick cows were the experience of the manipulator and the severity of the disease.     

Venous aneurysm of the jugular vein in horses

Venous anomalies of the jugular vein are uncommon in the horse. Jugular venous aneurysms (congenital or pseudoaneurysm) in horses usually present as a compressible asymptomatic cervical mass enlarging on manual congestion of the jugular vein. They can be classified into primary (congenital) and acquired lesions. Primary venous aneurysms are true venous aneurysms because in these lesions the venous wall is intact, whereas false or pseudoaneurysm has a disruption of the inner layers of the venous wall. Two types of jugular vein aneurysm can be identified, fusiform or saccular, the former being the most common in people. Doppler ultrasound imaging confirms the diagnosis. Surgical treatment, aneurysmectomy with venorraphy or venoplasty is indicated in case of progressive aneurysmal expansion. This clinical commentary describes a 4-month-old foal presented with a primary aneurysm of the right jugular vein in the midcervial region. Treatment consisted of partial aneurysmectomy and venorraphy. Four years later, the horse had a patent jugular vein with a normal diameter and was trained without clinical signs of venous distension.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 2: Short-term complications

REASONS FOR PERFORMING STUDY: Few studies have assessed short- and long-term complication rates of horses following surgical treatment of colic, a potentially fatal condition. Complications can lead to patient discomfort and increased costs; knowledge of predisposing factors may help to reduce complication rates. OBJECTIVES: To document and analyse short-term complications in 300 horses undergoing colic surgery, and to assess some of the possible predisposing factors. METHODS: History, clinical findings, surgical findings and procedures, and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Comparisons among groups of discrete data were made using chi-squared or Student's t tests as appropriate. RESULTS: Short-term complications in 227 horses following a single laparotomy included colic/pain (28.2%), incisional drainage or infection (26.9%), post operative ileus (13.7%), severe endotoxaemic shock (12.3%), jugular thrombophlebitis (7.5%), septic peritonitis (3.1%) and colitis/diarrhoea (2.2%). Horses with small bowel obstruction had a higher rate of post operative ileus than those with large bowel obstruction. Rates of post operative pain and shock were higher in horses with small colon rather than large colon obstruction, and in those that had an ischaemic rather than a simple obstruction. The rate of wound complications increased with increasing total plasma protein concentration at admission. Horses that had a repeat laparotomy had a higher rate of wound complications compared to those that had a single laparotomy. Application of a stent bandage was associated with a higher rate of wound complications than if no stent was applied; however, application of an incise drape over the wound for recovery was associated with a lower rate of wound complications than for horses that had no protective covering of the wound. CONCLUSIONS: The most common short-term post operative complications following colic surgery were pain, incisional drainage, ileus, endotoxaemiac shock and jugular thrombophlebitis. Some factors that appeared to predispose to these complications were identified. Although many of these factors related to the underlying disease process, a number of factors, including surgical techniques, were identified that might be amenable to modification. POTENTIAL RELEVANCE: Prospective studies to assess the effects of modifying these factors on survival rates should be performed.     

Coagulation in the equine intensive-care patient

Thrombotic disorders are common in the critically ill adult horse. Jugular vein phlebitis/thrombophlebitis, laminitis and organ, eg, colonic and/or pulmonary vessel thrombosis, are all important thrombotic disorders in the horse. Bleeding disorders are most commonly caused by thrombocytopenia or rupture of a large vessel. The measurement of clotting times, platelet number and function, fibrin degradation products and specific coagulation proteins, eg, Antithrombin III, can be routinely performed on the critically ill horse. Treatments for thrombotic disorders include fluids, plasma, anticoagulants and fibrinolytic enzymes. Treatments for bleeding disorders include fluids, blood products, aminocaproic acid, in addition to surgical repair or occlusion of an injured large vessel.     

Ultrasonographic evaluation of horses with thrombophlebitis of the jugular vein: 46 cases (1985-1988)

Medical records of 46 horses with jugular vein thrombophlebitis that were evaluated ultrasonographically were reviewed. The ultrasonographic appearance of the thrombus within the jugular vein was classified as noncavitating if it had uniform low to medium amplitude echoes, or as cavitating if it was heterogenous with anechoic to hypoechoic areas representing fluid or necrotic areas within the thrombus, and/or hyperechoic areas representing gas. Signs of pain on palpation of the affected vein (P less than 0.001), heat over the vein (P = 0.001), and swelling of the vein (P less than 0.05) were significantly associated with the ultrasonographic detection of a cavitating lesion. Ultrasonography also was useful for selecting a site for aspiration of a specimen for bacteriologic culturing and susceptibility testing.     

Marsupialization of Umbilical Vein Abscesses With Involvement of the Liver in 13 Calves

Omphalophlebitis with liver involvement was diagnosed by ultrasonography in 13 calves. In the initial surgical procedure, the infected umbilical vein was marsupialized by cranial trans-location in a median celiotomy and was flushed daily until healing occurred. In a second surgical procedure, the contracted umbilical vein was removed. Nine calves were clinically healthy after treatment. One had reformation of two abscesses because of inadequate post-surgical treatment. One calf was euthanatized because of an intussusception of the small intestine, and two calves had adverse reactions and developed septic shock when some of the lavage fluid, which was applied under pressure, entered the systemic circulation. It was concluded that umbilical vein abscesses should not be flushed under pressure in calves younger than 2 months of age. The principal advantages of cranial translocation of the umbilical vein in a median celiotomy are that only one abdominal incision is required and that the infected umbilical vein tissue does not have to be passed intraabdominally to a paramedian position.     

Comparison of canine capillary and jugular venous blood lactate concentrations determined by use of an enzymatic-amperometric bedside system

OBJECTIVE: To evaluate the analytical agreement between blood lactate concentrations determined by use of an enzymatic-amperometric bedside system in capillary blood samples from the pinna and in jugular venous blood samples from dogs. ANIMALS: 53 dogs. PROCEDURES: For each dog, venous and capillary blood samples were obtained from a jugular vein and from the ear pinna (by use of a lancing device), respectively, following a randomized sequence of collection. Lactate concentrations in both types of samples were analyzed by use of an enzymatic-amperometric bedside system intended for lactate detection in capillary blood samples from humans that was previously validated in dogs. The Passing-Bablock regression analysis was used to compare venous and capillary blood lactate concentrations; the level of agreement was calculated by use of the Bland-Altman method. RESULTS: Jugular venous blood samples were collected without difficulty from all 53 dogs. A capillary blood sample was obtained from only 47 dogs. The correlation coefficient between lactate concentrations measured in venous and capillary blood samples was 0.58 (slope, 2.0 [95% confidence interval, 1.5 to 3.0]; intercept, -1.2 [95% confidence interval, -3.1 to 0.4]). The mean difference between methods was 0.72 mmol/L (95% confidence interval, 0.38 to 1.06) with limits of agreement of -1.55 to 2.99 mmol/L. CONCLUSIONS AND CLINICAL RELEVANCE: Because of the lack of agreement between lactate concentrations determined in capillary and jugular venous blood samples, measurement of capillary blood lactate concentration in dogs performed with the technique used in the study does not appear to be a reliable alternative to jugular venous blood measurements.     

Use of skin staples for rapid closure of gastrointestinal incisions in the treatment of canine linear foreign bodies

A technique was developed for closure of gastrotomy and enterotomy incisions using disposable skin staples. The technique was used successfully in three dogs with gastrointestinal linear foreign bodies that required a gastrotomy and one or more enterotomies. The method allows for secure closure of gastrointestinal incisions and minimizes the surgical time in patients requiring multiple gastrointestinal incisions.     

Impact of the blood sampling site on time–concentration drug profiles following intravenous or buccal drug administration

The aim of this study was to examine the effect of the sampling site on the drug concentration–time profile, following intravenous or buccal (often called ‘oral transmucosal’) drug administration. Buprenorphine (20 μg/kg) was administered IV or buccally to six cats. Blood samples were collected from the carotid artery and the jugular and medial saphenous veins for 24 h following buprenorphine administration. Buprenorphine concentration–time data were examined using noncompartmental analysis. Pharmacokinetic parameters were compared using the Wilcoxon signed rank test, applying the Bonferroni correction. Significance was set at P < 0.05. Following IV administration, no difference among the sampling sites was found. Following buccal administration, maximum concentration [jugular: 6.3 (2.9–9.8), carotid: 3.4 (1.9–4.9), medial saphenous: 2.5 (1.7–4.1) ng/mL], area under the curve [jugular: 395 (335–747), carotid: 278 (214–693), medial saphenous: 255 (188–608) ng·min/mL], and bioavailability [jugular: 47 (34–67), carotid: 32 (20–52), medial saphenous: 23 (16–55)%] were higher in the jugular vein than in the carotid artery and medial saphenous vein. Jugular venous blood sampling is not an acceptable substitute for arterial blood sampling following buccal drug administration.     

Nitric oxide generation in a rat model of acute portal hypertension

OBJECTIVE: To document blood nitric oxide concentrations in the portal vein and systemic circulation in a rat model of acute portal hypertension and compare values with a control group and a sham surgical group. ANIMALS: 30 rats; 10 controls (group 1), 10 sham surgical (group 2), and 10 rats with surgically induced acute portal hypertension (group 3). PROCEDURE: Following induction of anesthesia, catheters were placed surgically in the carotid artery, jugular, and portal veins of group 2 and 3 rats and in the carotid artery and jugular vein of group 1 rats. Baseline heart and respiratory rates, rectal temperature, and vascular pressure measurements were obtained, and blood was drawn from all catheters for baseline nitric oxide (NO) concentrations. Acute portal hypertension was induced in the group 3 rats by tying a partially occluding suture around the portal vein and a 22-gauge catheter. The catheter was then removed, resulting in a repeatable degree of portal vein impingement. After catheter placement, all variables were remeasured at 15-minute intervals for 3 hours. RESULTS: Blood nitric oxide concentrations were greater in all vessels tested in group 3 than in group 2 rats. CONCLUSIONS AND CLINICAL RELEVANCE: Acute portal hypertension in this experimental model results in increased concentrations of NO in the systemic and portal circulation. On the basis of information in the rat, it is possible that increased NO concentrations may develop in dogs following surgical treatment of congenital portosystemic shunts if acute life-threatening portal hypertension develops. Increased NO concentrations may contribute to the shock syndrome that develops in these dogs.     

Chylothorax associated with thrombosis of the cranial vena cava

This study reviewed confirmed cases of concurrent chylothorax and cranial vena caval (CrVC) thrombosis in dogs and cats, and determined predisposing factors for the development of chylothorax associated with CrVC thrombosis. The extent and location of the thrombus, the treatment regime, and the outcome are described. In all 4 cases, implantation of a jugular device was a predisposing factor to thrombosis of the CrVC, and there was extensive thrombosis of the CrVC extending from at least 1 jugular vein to just cranial to the heart. Chylothorax resolved in 3 of the 4 cases after medical and/or surgical intervention. The development of chylothorax concurrently with thrombosis of the CrVC in dogs and cats is likely dependent on the extent and location of the thrombus. Veterinary patients with indwelling jugular devices that develop acute respiratory signs should be assessed for chylothorax associated with thrombosis of the CrVC.     

A study of seven different types of grafts for jugular vein transplantation in the horse

The aim of this study was to investigate the biological behaviour of vascular grafts replacing a section of the jugular vein in order to improve the results of the surgical treatment of complete thrombosis of the jugular vein in the horse. Seven graft types: fresh allograft, home frozen allograft, glutaraldehyde-fixed allograft, cryo-preserved allograft, PTFE-graft (Gore), small intestinal submucosa preparation (Cook) and fresh autograft, were randomly implanted in ponies. The grafts were removed after one month and examined histologically for: preservation of the graft structures, acceptance by the host, intima proliferation, presence of endothelium and patency. The glutaraldehyde- and cryopreserved grafts show reasonable results and the PTFE and autograft had the best results especially with respect to host acceptance, endothelium presence and patency. Further research is necessary to improve graft behaviour, especially to the aspect of endothelisation. Obstruction of the jugular vein in horses can be treated surgically.     

Correlation between jugular and central venous pressures in laterally recumbent horses

Objective To compare and correlate right atrial pressure, which represents central venous pressure (CVP) to jugular vein pressure (JVP) in laterally recumbent horses under anesthesia. Study design Retrospective clinical trial. Animals Seven adult healthy horses (411 ± 8.7 kg). Methods Horses were sedated with IV xylazine and anesthesia was obtained with IV ketamine and diazepam. Anesthesia was maintained with sevoflurane in oxygen. All horses were positioned in left lateral recumbency. An 8F catheter introducer was inserted into the right jugular vein to measure JVP. An 8F catheter introducer was inserted into the left jugular vein to be used as the port for a 7F 110 cm catheter that reached the right atrium to measure CVP. Both, CVP and JVP were measured simultaneously with a water calibrated aneroid manometer using the sternum as the 0 cmH₂O reference point. Measurements were compared using Spearman correlation and the Bland‐Altman plot. Results Twenty paired samples were obtained over a period of 2 hours. The CVP ranged from 7 to 31 cmH₂O, while the JVP ranged from 5 to 30 cmH₂O. The Spearman correlation coefficient indicated that CVP and JVP had a strong correlation with r = 0.88. The Bland‐Altman plot showed a bias of 0.7 cmH₂O. Conclusion and clinical relevance Jugular vein pressure showed a strong correlation with CVP in healthy, euvolemic, laterally recumbent anesthetized adult horses. Thus, JVP cannot replace CVP but it may be used clinically to monitor CVP in laterally recumbent horses.