Thrombosis of the median artery and its branches in a gelding: Clinical appearance,diagnosis and surgical management

This case report describes the clinical appearance, diagnosis and surgical management of thrombosis of the median artery and its branches in a gelding. The 4-year-old Danish Warmblood presented with acute severe progressive right front leg lameness, not responding to painkillers. Initial clinical examination including radiographs revealed no significant findings, and a scintigraphic examination showed decreased radiopharmaceutical uptake in the right front toe in comparison to the left limb. The following day, the temperature of the right front leg was significantly decreased, especially in the area distal to the carpus. No pulsation of the digital arteries could be detected. Ultrasonography showed partial thrombosis of the medial digital artery (A. digitalis palmaris medialis). Occlusion of this artery is a sporadic event with impressive clinical signs and might not be directly diagnosed due to it being a rare occurrence. Ultrasound is an excellent technique for diagnosing the presence of thrombosis and can also help delineate the extent. Our case did not respond to the initial treatment with phenylbutazone and acetylsalicylic acid. The ischaemia became even worse, requiring surgical intervention. A similar approach as for the aorta-iliac thrombosis in the hindlimb was undertaken in the front limb, which has not been described previously. The gelding recovered initially. Unfortunately, restenosis occurred and due to a poor prognosis for a second surgery, the gelding was euthanised.