Aortic-iliac thrombosis in a horse

A horse with a history of chronic lameness was presented with signs of abdominal pain. A diagnosis of intestinal obstruction was initially made and treatment was ineffective. Further examination revealed an aortic obstruction in the area of the bifurcation of the iliac vessels. Postmortem results supported the clinical findings. The clinical signs of aortic-iliac thrombosis are consistent with the lameness pattern and abdominal distress.     

Surgical thrombectomy in horses with aortoiliac thrombosis: 17 cases

Reasons for performing study: Aortoiliac thrombosis (AIT) is a progressive vascular disease characterised by an exercise‐induced hindlimb lameness. After developing a surgical technique, a follow‐up study was required. Objectives: To assess the surgical results of a surgical thrombectomy in horses with AIT, a chronic arterial occlusive disease of the aorta and its caudal arteries. Methods: Seventeen cases showed the typical signs of AIT and diagnosis was confirmed by Doppler‐ultrasonography. Average age of the horses was 12 years. Seven stallions, 6 mares and 4 geldings were included. Results: The thrombus was located in the left hindlimb (5 cases), the right hindlimb (9 cases) or in both hindlimbs (3 cases). Two cases were operated on both limbs with a few days between surgeries. Nine (53%) horses regained their athletic performance and 2 horses were able to work for at least 30 min without complaint, instead of the initial 5 min prior to surgery. During surgery one horse had to be subjected to euthanasia because the thrombus was too tightly attached to the arterial wall and could not be removed. Two horses were subjected to euthanasia post operatively due to severe myopathy and one due to a femoral fracture during recovery. Two reocclusions of the treated artery occurred 4 months after surgical intervention: one horse was reoperated and, due to the extent of the thrombus and quality of the arterial wall, the horse was subjected to euthanasia; the other horse was subjected to euthanasia without a second surgery. A severe complication was the appearance of AIT in the contralateral limb after surgery as result of occlusion caused by an embolus loosened by the procedure. Post anaesthetic myopathy was seen in 4 (24%) of the cases and could be so severe that euthanasia had to be considered. Conclusion and potential relevance: Surgical intervention by means of a thrombectomy in horses with AIT should be considered; 65% of the horses regained athletic activity and 53% of the operated horses in this study performed at their previous level. Adequate padding, correct positioning, prevention of intraoperative hypotension and keeping surgery time as short as possible, are important parameters to prevent post operative myopathy.     

Use of ultrasonography for the detection of aortic-iliac thrombosis in horses

Two dimensional ultrasonographic evaluation of the iliac arteries and terminal portion of the aorta was utilized in 18 horses with histories of exercise intolerance or hindlimb lameness. A plaque or thrombus was imaged in one or more of these vessels in 5 horses. In 2 horses, the initial rectal examination findings were normal and the thrombus may have been missed without the use of diagnostic ultrasonography.     

Prevention and treatment of thrombosis, phlebitis, and laminitis in horses with gastrointestinal diseases.

Organ thrombosis and laminitis are life-threatening complications in horses with acute gastrointestinal disease, especially those diseases that cause disruption of the protective mucosal barrier. Prevention of these complications should be a high priority when treating horses with gastrointestinal diseases because even with proper and intensive treatments, laminitis or organ thrombosis may not be curative. Preventative therapy should include expedient and appropriate treatment of the primary disease, normalization of tissue perfusion and oxygenation, and inhibition of gut-derived toxins or their systemically activated biologic products along with i.v. replacement of depleted anticoagulant proteins. Additionally, several risk factors for thrombophlebitis in horses with intestinal disease have been identified, and those risk factors should be minimized during the illness.     

Acute thrombosis of limb arteries in horses with sepsis: five cases (1988-1998)

A hypercoagulable condition and poor perfusion to distal extremities might occur during equine endotoxaemic or septic shock, which could cause thrombosis of limb arteries. In our review, thrombosis occurred in neonatal foals in association with gram-negative bacteraemia. In 3 older foals and adults, thrombosis was associated with inflammatory bowel disease, diarrhoea and toxaemia. All patients had been treated with broad-spectrum antibiotics, nonsteroidal antiinflammatory drugs and i.v. crystalloid solutions. Two horses received i.v. hyperimmune plasma. A generalised coagulopathy was not suspected prior to clinical signs of distal limb necrosis, although thrombocytopenia occurred in 4 of the 5 cases at the time of, or shortly before, thrombosis. Thrombocytopenia, possibly due to platelets adherence to exposed subendothelial collagen, which induces contact activation of the intrinsic coagulation pathway, has been described in endotoxaemic horses and foals with gastrointestinal infectious or inflammatory diseases and disseminated intravascular coagulation. Activation of procoagulants by endotoxins, decreased blood flow to the limbs and endothelial damage, may have been responsible for a hypercoagulable condition leading to thrombosis in these 5 cases. The 3 enterocolitis patients may have had increased risk of thrombosis because of loss of antithrombin III, haemoconcentration and acidosis.     

Mesothelioma in horses

Pleural mesothelioma and pericardial mesothelioma with spread to the pleural cavity were diagnosed in 2 horses. Clinical signs included respiratory distress, depression and pleural pain. The affected body cavities contained copious, serous effusions containing very large neoplastic mesothelial cells with densely-staining cytoplasm, hyperchromic nuclei and prominent, often multiple, nucleoli. Ultrastructurally, the neoplastic cells appeared as solid aggregates, with profuse microvillous borders and neolumen formation. Cytological examination, together with confirmative ancillary diagnostic tests, including electron microscopy and immunocytochemistry, may be used to obtain an ante-mortem diagnosis of mesothelioma.     

Intersexuality in horses

Intersexuality is a rare congenital anomaly of horses. Diagnosis of intersexuality is difficult because there are usually no specific changes in the reproductive tract visible. During a period of five years, ten patients with reduced fertility or suspected intersexuality respectively were investigated using cytogenetic, molecular genetic, histopathological and endocrinological methods. In one case a 64,XX/63,X0 mosaicism was found. In six cases male pseudohermaphroditism was verified. These patients showed a male karyotype, testes and rudimentary parts of a female reproductive tract were present. One horse was suspected to be a male pseudohermaphrodite but the gonads were not examined. One horse was suspected to be affected by an XX-sex several syndrome and in one case a SRY-negative XY-sex reversal syndrome was most likely. In the case of an XX-sex reversal syndrome, there is a female chromosomal constitution, an uterus and cranial parts of the vagina are present but also testes tissue and possibly an enlarged penis like clitoris. Here an XX-sex reversal syndrome was suspected but not confirmed as it was not possible to examine the gonads and verify tissue from testes. Therefore a pseudohermaphroditismus femininus could not be excluded. In cases of XY-sex reversal syndrome the patients show a male chromosomal constitution, parts of a female reproductive tract but no testes tissue is present. For the horse described here, a deletion of the SRY gene was the most likely cause for the XY-sex reversal syndrome.     

Enteroliths in horses

Many cases of enteroliths were reported in the nineteenth century but the number greatly decreased in the early twentieth century. However, in recent years the number of cases in certain parts of the United States such as California has greatly increased. The reasons for the increase are obscure. The intake of nitrogen, magnesium and phosphorus (the primary components of enteroliths) from water and food is likely to be a factor. Arabians may be more likely to develop enteroliths than horses of other breeds. A nidus such as a small stone is needed because a nidus has been found in every enterolith that has been examined. Further studies in which the effect of mineral intake and form of the mineral on enterolith formation are needed. Studies of enterolith formation in the past have all been retrospective. Models for the development of enteroliths are needed.