Use of saline contrast ultrasonography in the diagnosis of complete jugular vein occlusion in a horse.

Background: Thrombophlebitis and thrombosis are the most common causes of jugular vein occlusion in horses. Medical and surgical treatments aim to recanalize the occluded vessel and reduce proximal venous congestion and edema. Case Description: The present report describes a clinical case of equine jugular vein thrombosis (JVT) with complete vein occlusion diagnosed by saline contrast ultrasonography (SCU) and confirmed by contrast venography. Conclusion: Our results demonstrated that the SCU test can be easily performed and objectively interpreted using standard ultrasound equipment; it is not expensive and it does not require x-ray exposure. The SCU test is a valid tool to assess vessel patency and presence of collateral circulation in JVT. The test could therefore be used to monitor the progression of the disease and the effectiveness of therapy against JVT in horses.

An atypical presentation of leiomyosarcoma causing extremity compartment syndrome of the crural region in a Dutch Warmblood mare: a case report.

A 12-year-old Warmblood mare was presented with an acute onset left hindlimb lameness associated with generalised soft tissue swelling of the entire limb and medial saphenous vein (MSV) thrombophlebitis. A presumptive diagnosis of extremity compartment syndrome (ECS) was made. Due to the clinical deterioration, emergency fasciotomy of the crural fascia and biopsy was performed. Histological and immunohistochemical examination of the samples confirmed a diagnosis of leiomyosarcoma likely originating from the tunica media of the MSV. This report is the first to describe an unique combination of ECS and thrombophlebitis associated with a leiomyosarcoma in a horse.

Cranial superficial epigastric vein phlebitis and septicemia in dairy cows in Brazil.

Cases of cranial superficial epigastric vein (CSEV) phlebitis with subsequent septicemia were observed in dairy farms in Minas Gerais, Brazil. Autopsy on 4 affected cows, from 2 farms, revealed CSEV thrombophlebitis with perivascular abscesses, pulmonary abscesses, valvular endocarditis, arthritis, thromboembolic nephritis, and renal infarcts. Microscopic examination revealed fibrosing and lymphoplasmacytic phlebitis with occasional endothelial loss, subendothelial areas of necrosis, and abundant fibrin deposition. Trueperella pyogenes, Escherichia coli, and Staphylococcus aureus were isolated from lesions of 3 different cows. Thrombophlebitis of the CSEV is a rare condition in dairy cows; however, it has become more frequent in dairy farms in southeastern Brazil after repeated venipuncture of this vein, likely with contaminated needles used for administration of oxytocin.

Complications of intravenous catheterization in horses.

INTRODUCTION: Intravenous catheterization is a necessity for continuous administration of intravenous fluids and for intermittent intravenous access to avoid discomfort and potential complications of repeated needle insertions into the vein. Intravenous catheterization is commonly performed and well tolerated in horses, but catheter associated complications have been reported. The most commonly reported complication is thrombophlebitis, but others such as venous air embolism, exsanguination and catheter fragmentation may also occur. This article aims to review clinical signs, pathogenesis, diagnosis, therapy, risk factors and prevention of common catheter associated complications.

INTRODUCTION: Le cathétérisme veineux est une nécessité pour l'administration continue de fluides par voie intraveineuse et pour garantir un accès veineux intermittent afin d'éviter l'inconfort et les complications potentielles liées à la pénétration répétée d'une aiguille dans la veine. Le cathétérisme veineux est usuellement pratiqué chez le cheval et il est bien toléré mais des complications associées sont rapportées. La plus commune d'entre elle est la thrombophlébite mais d'autre, telles l'embolie gazeuse, l'exsanguination ou la fragmentation du cathéter peuvent aussi survenir. Cet article vise à résumer les signes cliniques, la pathogénèse, le diagnostic, le traitement les facteurs de risque et la prévention des complications communément associées avec le cathétérisme.

Thromboelastometric evaluation of horses submitted to experimental thrombosis and jugular thrombectomy / Avaliação tromboelastométrica de equinos submetidos a trombose e trombectomia jugular experimental

Jugular thrombosis in horses occurs commonly in iatrogenic situations, secondary to endotoxemic clinical condition and disseminated vascular coagulation, potentially leading to death. Thus, hemostatic evaluation becomes necessary and extremely important for monitoring the risks of systemic hypercoagulability and for the efficiency of allopathic and surgical treatment. This paper describes the hemostatic behavior in experimental jugular thrombosis of ten healthy equines, subsequently submitted to two thrombectomy techniques and receiving heparin sodium as anti-rethrombosis therapy. These animals were evaluated for 20 days by thromboelastometry (TEM), platelet count, hematocrit and fibrinogen, at four moments: pre-induction to phlebitis (D0-MPF); three days after thrombophlebitis induction (D3-MFM); 6 days after, - moment of thrombophlebitis - (D9-MT); and 54 (D16) and 126 (D19) hours after thrombectomies (PTM). Thrombectomy was performed via a Vollmar Ring (group 1, n=5) and Fogarty catheter (group 2, n=5). All the animals received heparin (150 UI/kg, SC) every 12 hours, for ten days after the respective thrombectomies. Through the blood samples were evaluated TEM, activated partial thromboplastin time (aPTT) and prothrombin time (PT), dosing of fibrinogen, hematocrit and platelet count at the abovementioned moments. For comparison between groups and moments the t test was applied at 5% significance level. No significant difference was verified between treatment groups at any of the moments. There were reductions in clotting time (CT) and clot formation time (CFT), with increase in maximum lysis (ML) until the moment D9-MT. Evaluation through INTEM® reagent presented prolongations of CT and CFT with reduction of α angle and ML starting from D16 and D19. Similarly, aPTT presented significant differences between moments pre- (D0, 3 and 9) and post- (D16 and 19) anticoagulant and surgical treatment. The platelet numbers were diminished at moments D16 and D19. In evaluation with EXTEM® reagent, prolongation of CT and CFT occurred only between the moments D0 vs. D3 and vs. D9. O PT did not present significant differences. The results obtained demonstrate that experimental jugular thrombophlebitis leads to local clinical alterations, with impairment of tissue and of the extrinsic coagulation pathway (EXTEM® ), but without evidence of systemic hypercoagulability status, since there was no increase of the alpha angle or maximum clot firmness (MCF). Furthermore, TEM was shown useful and more sensitive than conventional coagulation tests (PT, aPTT and fibrinogen) for the monitoring of anticoagulant therapy, as demonstrated in other works.(AU)

A trombose jugular nos equinos ocorre comumente em situações iatrogênicas, secundárias a quadros endotoxêmicos e a coagulação vascular disseminada, podendo levar ao óbito. Por isso, avaliação hemostática se faz necessária e de extrema importância para monitorar os riscos de hipercoagulabilidade sistêmica e também a eficiência do tratamento alopático e cirúrgico. Este trabalho descreve o comportamento hemostático na trombose jugular experimental de dez equinos hígidos, submetidos posteriormente a duas técnicas de trombectomia e recebendo heparina sódica como terapia anti retrombosante. Estes animais foram avaliados durante 20 dias por tromboelastometria (TEM), contagem de plaquetas, hematócrito e fibrinogênio, em quatro momentos: pré-indução à flebite (D0-MPF); três dias após a indução da tromboflebite (D3-MFM); 6 dias após, - momento de tromboflebite - (D9-MT); e 54 (D16) e 126 (D19) horas após as trombectomias (MPT). A trombectomia foi realizada com Anel de Vollmar (grupo 1, n=5) e cateter de Fogarty (grupo 2, n=5). Todos os animais receberam heparina (150 UI/Kg, SC) a cada 12 horas, durante dez dias após as respectivas trombectomias. Através de amostras de sangue, foram avaliadas a TEM, o tempo de tromboplastia parcial ativada (TTPa) e tempo de protrombina (TP), a dosagem de fibrinogênio, hematócrito e contagem de plaquetas nos momentos descritos acima. Para a comparação entre os grupos e momentos foi aplicado teste t, com nível de significância de 5%. Não foi verificada diferença significativa entre os grupos de tratamento em nenhum dos momentos. Houve redução do tempo de coagulação (CT) e do tempo de formação do coágulo (CFT), com aumento da lise máxima (LM) até o momento D9-MT. A avaliação com o reagente intem apresentou prolongamento do CT e do CFT e redução do ângulo α e da LM a partir do D16 e D19. Da mesma forma, o TTPa apresentou diferenças significativas entre os momentos pré (D0, 3 e 9) e pós (D16 e 19) tratamento cirúrgico e anticoagulante. Houve diminuição do número de plaquetas nos momentos D16 e D19. Na avaliação com reagente extem ocorreu apenas o prolongamento do CT e CFT entre os momentos D0 e o D3 e D9. O TP não apresentou diferenças significativas. Os resultados obtidos demonstram que a tromboflebite jugular experimental leva a alterações clínicas locais, com comprometimento tecidual e da via extrínseca da coagulação (extem), porém sem evidências de um estado sistêmico de hipercoagulabilidade, pois não houve aumento do ângulo alfa e da firmeza máxima do coágulo (MCF). Além disso, a TEM se mostrou útil e mais sensível que os testes convencionais de coagulação (TP, TTPa e fibrinogênio) para o acompanhamento da terapia anticoagulante, conforme demonstrado em outros trabalhos.(AU)

Jugular thrombophlebitis in horses: a review of fibrinolysis, thrombus formation, and clinical management.

Thrombophlebitis of the jugular vein is commonly observed in horses, particularly during intensive care, and leads to local and systemic inflammatory responses as well as head and neck circulatory impairment. Thrombolytic therapy is widely used in human practice with the aim of thrombus dissolution and recanalization of the injured vessels. There are similarities between human and horse coagulation and fibrinolytic processes. This review examines the fibrinolytic system, thrombus formation, and the clinical management of jugular thrombophlebitis, including thrombolytic therapy. There is evidence that early regional thrombolytic therapy for jugular thrombophlebitis in horses may be effective to achieve sustained recanalization.

Thrombophlébite jugulaire chez les chevaux : revue de la fibrinolyse, de la formation de thrombus et de la gestion clinique. La thrombophlébite de la veine jugulaire est communément observée chez les chevaux, particulièrement durant les soins intensifs, et cause des réactions inflammatoires locales et systémiques ainsi que des altérations de la circulation dans la tête et le cou. La thérapie thrombolytique est couramment utilisée en pratique humaine dans le but de dissoudre les thrombus et de recanaliser les vaisseaux blessés. Il y a similitudes entre les processus coagulant et fibrinolytique des humains et des chevaux. Cette revue examine le système fibrinolytique, la formation de thrombus et la gestion clinique de la thrombophlébite jugulaire, incluant la thérapie thrombolytique. Il y a des preuves que la thérapie thrombolytique régionale précoce pour la thrombophlébite jugulaire chez les chevaux peut être efficace pour la réalisation d'une recanalisation durable.(Traduit par Isabelle Vallières).

Surgical treatment of septic jugular thrombophlebitis in nine horses.

OBJECTIVE: To report a technique for surgical treatment of septic jugular thrombophlebitis unresponsive to medical treatment. STUDY DESIGN: Case series. ANIMALS: Horses (n=9) with septic jugular thrombophlebitis unresponsive to medical treatment. METHODS: Jugular vein thrombectomy was performed under standing sedation and local anesthesia. The contents of the affected portion of vein were removed by multiple incisions in the vein, with the incisions left open to drain and heal by second intention. RESULTS: The technique was curative in all instances, although 2 horses required a 2nd procedure. One horse required ligation of the linguofacial vein to control postsurgical hemorrhage. CONCLUSIONS: The technique is an effective surgical treatment for septic jugular thrombophlebitis unresponsive to medical treatment. CLINICAL RELEVANCE: Jugular vein thrombectomy is a straightforward technique, and has minimal postoperative complications. It allows expedient and cost-effective resolution of medically recalcitrant cases of septic jugular thrombophlebitis.

Jugular thrombophlebitis developed from buccal ulcer in a thoroughbred horse.

A 22-year-old Thoroughbred stallion had severe left jugular thrombophlebitis. Macroscopic and microscopic examinations revealed extension of the lesions from a penetrating ulcer on the left buccal mucosa to the underlying muscle and local vein, and sequentially to the left jugular vein. This was a rare case of equine jugular thrombophlebitis caused by direct extension of infection from a traumatic oral lesion.

Evaluation of athletic performance in horses with jugular vein thrombophlebitis: 91 cases (1988-2005).

OBJECTIVE: To evaluate effects of thrombophlebitis of 1 or both jugular veins on athletic performance of horses. DESIGN: Retrospective case series. ANIMALS: 91 horses with jugular vein thrombophlebitis. PROCEDURES: Medical records of horses with jugular vein thrombophlebitis examined between 1988 and 2005 were reviewed for signalment, history, clinical signs, diagnosis, and treatment. Performance was evaluated in 2 ways. A questionnaire was used to obtain a subjective assessment from the owner or trainer of the horse's performance after thrombophlebitis, compared with the performance before thrombophlebitis. Racing records from before and after thrombophlebitis were also evaluated. RESULTS: Thrombophlebitis was diagnosed in 37 horses at the time of admission (group 1), and 54 horses developed thrombophlebitis during hospitalization for an unrelated medical condition (group 2). Twenty-seven of 81 (33%) owners answered the questionnaire, and racing records were available for 31 horses. Performance data were available for 48 horses. Owners reported that all nonracing horses, except 1, had equivalent or better performances after discharge. Twenty-six of 31 (84%) Standardbreds resumed racing; in these horses, there was no significant difference between racing times before and after thrombophlebitis. No significant difference in performance was detected regardless of the primary disease, whether a horse had unilateral or bilateral thrombophlebitis, or the treatment administered. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the athletic performance of horses used for nonracing events was not affected by thrombophlebitis. Thrombophlebitis in racing Standardbreds was associated with a decreased chance of return to racing; however, performance was not impaired in those that resumed racing.

Assessment of subclinical venous catheter-related diseases in horses and associated risk factors.

A total of 102 horses that had a catheter introduced intravenously to facilitate treatment had the catheterised jugular vein and contralateral vein examined by ultrasound every 48 hours. Subclinical complications were defined by thrombus formation or thickening of the venous wall, and the data were analysed to establish risk factors for the development of these complications. The horses with a rectal temperature above 38.5 degrees C when the catheter was introduced were four times more likely to develop complications, than the horses with a lower temperature. The administration of a NSAID while the catheter was in place reduced the risk of complications developing.

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.

A hematogenic pleuropneumonia caused by postoperative septic thrombophlebitis in a Thoroughbred gelding.

A 7-year-old Thoroughbred gelding was admitted to Equine Hospital, Korea Racing Association for evaluation and treatment of colic. Based on the size and duration of the large colonic and cecal impaction, a routine ventral midline celiotomy and large colon enterotomy were performed to relieve the impaction. Six days following surgery the gelding exhibited signs of lethargy, fever, inappetence and diarrhea. Eleven days following surgery, the jugular veins showed a marked thrombophlebitis. On the sixteenth day of hospitalization the gelding died suddenly. Upon physical examination, the horse was febrile, tachycardic and tachypnoeic. Thoracic excursion appeared to be increased; however, no abnormal lung sounds were detected. No cough or nasal discharge was present. Hematology revealed neutrophilic leukocytosis. Serum biochemistry was normal but plasma fibrinogen increased. In necropsy, fibrinopurulent fluid was present in the thoracic cavity. There were firm adhesions between visceral pleura and thoracic wall. White, mixed and red thrombi were formed in both jugular veins from the insertion point of IV catheter. Histopathological examination showed fibrinopurulent inflammation and vascular thrombosis in the lung. The pleura showed edematous thickening and severe congestion. The clinicopathological and pathological findings suggest that septic thrombi associated with septic thrombophlebitis metastasized into the pulmonary circulation and were entrapped in the pulmonary parenchyma and provoked pleuropneumonia.

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.

Factors influencing the occurrence of thrombophlebitis after post-surgical long-term intravenous catheterization of colic horses: a study of 38 cases.

Thrombophlebitis is a well-known complication of the use of long-term in-dwelling catheters. In humans, catheter material has been shown to strongly influence the occurrence of thrombophlebitis. In the horse, the influence of catheter material has been studied in healthy experimental animals, but information on the relative importance of this factor is lacking. To investigate which factors have most impact on the frequency of jugular vein thrombosis in post-surgical colic horses, a clinical study was performed on 38 animals. Horses were randomly divided into two groups. In one group a polytetrafluoroethylene catheter was used, in the other a polyurethane catheter. Both groups were clinically monitored and screened for signs of thrombophlebitis. Seven out of 38 horses developed thrombophlebitis. The type of catheter material used had no influence on thrombophlebitis development. Dwell time was significantly longer in horses that developed thrombophlebitis compared with those that did not. There was no relationship between the occurrence of thrombophlebitis and underlying disease or surgical treatment, suggesting that the general state of debilitation these horses experienced was the most important determinant for the development of thrombophlebiris. This was further stressed by the fact that seven horses developed thrombophlebitis of the contralateral vein that had been used for the induction of anaesthesia (this incidence is much higher than in horses anaesthetized for elective surgery). It is concluded that the state of debilitation is the most important determining factor for the occurrence of thrombophlebitis after the use of long-term in-dwelling intravenous catheters. This makes a substantial reduction of the incidence of thrombophlebitis difficult, but some progress can be made by consequently restricting dwell time.

Eosinophilic proliferative pylephlebitis in the liver of Japanese beef cattle with fascioliasis.

Intrahepatic pylephlebitis was detected in 17 Japanese beef cattle. Grossly, the intrahepatic vessels in the caudate lobe and/or in the periphery of the other hepatic lobes were thickened and protruded above the lobar surface. The vessel lumina were packed with white to red, waste thread-like contents. A few immature flukes were found in the bile ducts in 3 of the 7 cases with biliary thickening. Foci of hepatic necrosis and hemorrhage were scattered around the thickened vessels in 8 cases. Histologically, the interlobular veins were thickened due to severe intimal hyperplasia with endothelial proliferation and eosinophilic accumulation and medial hypertrophy, accompanied by fibrosis and eosinophilic infiltration in the portal areas. Hepatic tissues with necrosis and hemorrhage were surrounded by eosinophils and histiocytes including a granulomatous reaction. One immature fluke was detected in one of these regions of necrosis. Immunoperoxidase staining revealed that the small fluke, Kupffer cells, and histiocytes in the liver of all cases were positively stained with anti-Japanese Fasciola sp. antiserum. Enzyme-linked immunosorbent assay of the sera of 15 cases revealed that all were positive for the anti-Fasciola antibody. On the basis of these findings, the present cases were regarded as an atypical form of fascioliasis, characterized by eosinophilic proliferative pylephlebitis of the liver.

Long-term ultrasonographic and venographic study of the development of tarsal vein thrombosis in a cow.

The development of thrombosis of three tarsal veins in a cow was studied by repeated ultrasonographic and venographic examinations for nine months. The venous diameter, the echogenicity of the thrombi and the sequential venographic findings were evaluated. Initially, the thrombosed parts of the ramus cranialis and caudalis of the vena saphena lateralis and the ramus caudalis of the vena saphena medialis had greatly increased diameters and were not compressible. The thrombi appeared as poorly echogenic masses. Within five months, the diameters of the occluded veins had decreased to almost normal dimensions. The echogenicity of the thrombi diminished at their distal and proximal ends. The length of the thrombi was decreased by up to 6.5 cm. However, the thrombosed veins did not re-open. One year after diagnosis, the cow was culled and the persistence of the venous thromboses was confirmed.

Prophylaxis of intravenous catheter-related thrombophlebitis in cattle.

Two methods of preventing intravenous catheter-related thrombophlebitis of the jugular vein, using clinical and ultrasonographic criteria, were compared. The first method consisted of minimising bacteriological contamination by the preparation of the skin as if for surgery. The second method involved the daily subcutaneous administration of low doses of heparin to decrease procoagulant activity. The results showed that the preparation of the skin before the placement of an indwelling catheter in the jugular vein and adequate daily maintenance of the catheter were of great importance in the prevention of thrombophlebitis induced by bacteriological contamination. The use of heparin should be limited to cases that require long-term catheterisation or are predisposed to thrombosis or other clotting abnormalities.

Application of real-time ultrasonography for the detection of tarsal vein thrombosis in cattle.

The clinical and ultrasonographic features of the thrombosis of three tarsal veins in a six-year-old dairy cow are described. Thrombosis and metastatic abscessation developed on the left tarsus six days after the amputation of the lateral claw of the left hindlimb. Originally, the cow suffered from a severe purulent arthritis of the distal interphalangeal joint and a retroarticular abscess, caused by interdigital necrobacillosis. By means of real-time ultrasonography, using a 7.5 MHz transducer, a marked subcutaneous oedema, a subcutaneous abscess, and a thrombosis of the ramus cranialis and ramus caudalis of the vena saphena lateralis reaching the confluence into the vena saphena lateralis and a thrombosis of the ramus caudalis of the vena saphena medialis could be identified. The thrombosed veins were not compressible, were oval and had an increased diameter of up to 9 x 12 mm. Intraluminal masses were visualised as hypoechoic structures and the veins distal to the thrombosis were distended up to 10 x 13 mm. The differential diagnosis and pathogenesis of the thrombosis and the abscessation are discussed, and the clinical course and the sonographic observations of the thrombosis during a six week period are described.

Ultrasonographic evaluation of the jugular vein of cows with catheter-related thrombophlebitis.

Thirty cows with an indwelling jugular catheter developed thrombophlebitis 72 hours after the insertion of the catheter. The animals with palpable changes of the jugular vein, were examined ultrasonographically to reveal the severity and extent of the thrombosis. Sixteen cows had mild to moderate thrombotic changes at the site of insertion or at the tip of the catheter, and in the other 14 cows the jugular vein was completely thrombosed, from 7 to 20 cm. Catheter-related damage to the intima, chemical damage by irritating medications and reduced host resistance attributable to the underlying illness were thought to be possible causes of the thrombophlebitis.