# Thrombosis in jugular vein



## LynH (13 October 2010)

Hi. My mare has a thrombosis in her jugular vein following a catheter inserted for IV fluids and replacement proteins when she was admitted to vet hospital with colitis for six days. 

She has a large infected mass in the vein as well as oedema around the vein. The lump in her neck is the size of a grapefruit and very hard and hot at times. Her right cheek and jowl are very swollen. 

She has been on antibiotics, antiinflammatories and blood thinners for weeks with only minor improvement. Next step is to have the jugular vein removed..

Has anyone had a horse with a jugular vein thrombosis or a vein removed? The vet has said that the surgery will result in consideable nerve damage and scarring to her neck which would impact flexion and prevent her from doing dressage. Does anyone have any experience of this and how horses are affected long term?

She was lucky to survive the colitis and I am concerned that surgery could trigger it again and put her under stress when the outcome is not without complications and long term issues.


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## Box_Of_Frogs (14 October 2010)

Ye gods! Can they remove the entire jugular vein????? Can a horse survive that???? No experience hun but what a nightmare it all sounds. Thinking of you and fingers crossed that it starts to respond to treatment xxx


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## ImogenBurrows (14 October 2010)

I've never heard of the removal of a jugular vein - not something I'd want to undertake!!  

There are surgical treatments for non-repsonsive jugular thrombophlebitis cases - these generally revolve around the removal of the clot itself rather than the vein - could this be what your vet meant? http://onlinelibrary.wiley.com/doi/10.1111/j.1532-950X.2010.00683.x/full

I'd be really worried about leaping straight to vein excision without trying to remove the clot surgically first.

Often medical treatment is successful but it does sound like you've given it a fair crack of the whip already so surgery maybe the next port of call.  I'd maybe suggest that you discuss clot removal with the vets ad say what they say about that idea. I don't like the idea of the side effects....I'm guessing from the nerve damage risks it is the left side? 

Some of the previously occluded veins will recannulate over time by themselves anyway, but septic clots DO need aggressive treatment for obvious reasons.

Good luck and keep me updated!
Imogen


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## ImogenBurrows (14 October 2010)

Amendment to first post....have found reports of jugular vein removal now (known as "stripping") - http://books.google.co.uk/books?id=...&resnum=5&ved=0CC4Q6AEwBA#v=onepage&q&f=false

Good luck to the vets doing it!!!!  I assume seeing as this has been offered your vets is a major clinic!

Best of luck
Imogen


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## LynH (14 October 2010)

Apparently they can survive with just one jugular vein but the major risk is they need to put a catheter in the other jugular vein to enable them to remove the infected one. If the second vein gets a phlebitis then you lose the horse. 

I believe stripping the vein is preferable as there is considerable risk of pulmonary embolism and systemic infection if parts of the thrombosis are dislodged during a thrombectomy. 

My mare was scanned again today after 7 weeks of medication and there is finally some flow of blood through the jugular vein and the phlebitis/infection is decreasing. There is a very hard lump of inflamed muscle on top of the thrombosis which externally looked like the thrombosis had enlarged. The aim now is to continue with antibiotics, anti-inflammatories and blood thinners for another two weeks and hope that it continues to improve. I am keeping my fingers crossed that this remains non-surgical. 

One bonus - I am guessing the colitis is completely healed as her digestive system is coping really well with high levels of medication.

Thank you for your comments. I had struggled to find much out about the prognosis after stripping the vein.


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## ImogenBurrows (14 October 2010)

I'm glad things are looking on the up!!!

Most horses do very well on the one jugular even at high exercise levels - obviously once the sepsis has resolved.  I hope things keep going in the right direction. 

When I have dealt with one patent side only horses for other reasons, I have often tried to use veins other than the remaining jugular for catheters as you are quite right - they can't cope with none! I prefer to try using the cephalic on the forearms, saphenous on the hindlegs or my fav the lat thoracic on the ribcage!

Good luck, fingers crossed.
Imogen


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## HFlynnDVM (27 October 2010)

Lyn,

the jugular thrombosis is one of the symptoms of colitis in the horse. It is probably not (99%) a result of needle or catheter placement. I have had two over the past year, one has completely resolved with collateral circulation and one that i am presently treating. If you Google equine colitis you will find that jugular thrombosis is one of the cardiopulmonary symptoms of the disease. In my present case, the horse has exhibited a cold nose before her colic symptoms and at other times has shown swelling of the head. 

I would suggest leaving the jugulars alone or just use cold packs and avoid surgery unless it is only to drain the area. It sounds like your vet is doing the right thing. If you or your vet would like to contact me, my email address is: HFlynnDVM@aol.com

Good luck the colitis treatment requires a committment 

H Flynn DVM
Medford, New York


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## ImogenBurrows (27 October 2010)

HFlynnDVM said:



			Lyn,

the jugular thrombosis is one of the symptoms of colitis in the horse. It is probably not (99%) a result of needle or catheter placement. I have had two over the past year, one has completely resolved with collateral circulation and one that i am presently treating. If you Google equine colitis you will find that jugular thrombosis is one of the cardiopulmonary symptoms of the disease. In my present case, the horse has exhibited a cold nose before her colic symptoms and at other times has shown swelling of the head. 

I would suggest leaving the jugulars alone or just use cold packs and avoid surgery unless it is only to drain the area. It sounds like your vet is doing the right thing.

H Flynn DVM
Medford, New York
		
Click to expand...

That's really interesting stuff.  I haven't seen this present as a symptom, lucky I guess, but will look out for it in the future! Thanks. 

Imogen


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## LynH (30 October 2010)

[QUOTE  In my present case, the horse has exhibited a cold nose before her colic symptoms and at other times has shown swelling of the head.]

My horse has had problems with head swelling previously too.  After sedation her head often swells and has to be held up.  She is also prone to grass glands particularly when it is windy.

I found a study online which stated that horses who have received anti-diarrheal drugs prior to catherisation are 31 times more likely to get a thrombosis and also horses with low protein levels often associated with colitis are 5 times more likely to get a thrombosis.  It was also very highly likely when the colitis was caused by salmonella.

By the way, my horse is finally starting to improve and I am hoping that with continued hot compressing, and medication surgical intervention wont be necessary.

Thank you all so much for your advice.
Lyn


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## LynH (30 October 2010)

[QUOTE
Good luck the colitis treatment requires a committment ]

I am currently feeding her several small feeds a day, we bought hay from a different source and she has been on Protexin and Happy Tummy charcoal.  I have been advised to keep her in as stressfree an environment as possible and am fully aware that it will be a while before she is well enough to tolerate the stress of competing, travelling etc.

After an initial relapse once she came home from the Equine Hospital she has only had one bout of loose droppings and has tolerated the thromboplebitis treatment well.  I am hopeful that she has no symptoms of gastro ulcers as a result of the colitis.

I have been a little over protective initially and sterilised her stable before she came home and have sterilised her feed bowls etc. As the cause of the colitis wasn't determined I was very concerned about a reoccurance. 10 weeks later I feel cautiously optimistic about both the colitis and finally now about the thrombosis.


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## LynH (27 November 2010)

Hi. I just wanted to follow up and this and ask some further advice...

Several weeks on and my horse seems fully recovered from the colitis and the thrombosis in the jugular vein has reduced and there is better blood flow through the vein. The only problem is that there is now a huge lump of organised muscle where the oedema was surrounding the thrombosis.  This is now about 2x5 inches and a couple of inches deep. It is rock hard and she reacts to it being touched so I guess it is painful.

We took her off antibiotics and there doesn't appear to be any sign of infection. We have used compagel, hot and cold compresses and now arnica and msm. Somedays the lump looks much smaller then other times it is a very noticeable enormous hard lump.  

I haven't found any useful information on google as to what treatment a lump in the muscle like this requires. both my vet and referral vet suggest removing the lump but as it is still up and down I would like to try more non-surgical treatments first..

Any ideas very gratefully received. Thanks.


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## glenruby (27 November 2010)

Has DMSO been used along the way? I would think its likely to be fibrosed tissue rather than muscle per say. Id continue with medical treatments and perhaps try physiotherapy a little further down the line. I have a horse with a haematoma on his cannon bone which has formed adhesions and is now getting physio - i suspect it could be used for a similar effect in this case.


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## LynH (8 December 2010)

I am using DMSO at the moment.  I asked my physio for her advice, as there was a possibility of dislodging the infection within the jugular vein and causing a systemic infection she was reluctant to help at that point.

On a positive note, we finally had a bit of a breakthrough last week.  The thrombosis/hard lump had grown to about 4"x6"x2" and seemed to be really irritating her. Last week a softer lump appeared on top of the hard lump and with poulticing it grew to the size of a golf ball.  The vet then lanced it and as expected a relatively small amount of pus was drained, about 20mls.  At least the infection has worked it's way out and the hard lump is now responding to massage.  I think the fact that it has abscessed has resulted in significant relief to the mare and she is now tolerating the massage.  We are planning to rescan the area next week once we have fully flushed out the abscess, I will let you know if the vet thinks it is fibrosed tissue rather than his initial suggestion of organised muscle.  Maybe once the abscess has healed a physio may be able to be of further help.

Thanks so much to HFlynn DVM and others, your help in this thread and by PM has been much appreciated.


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## Rooty (9 October 2011)

Am going to revive this as I have a horse who has developed phlebitis secondary to catheterisation for Potomac Horse Fever. Right now the lump is quite small and not hot, no fever.
My vet is not on call this weekend and am dealing with one who I am not entirely comfortable with. To boot it is a long weekend so it will be Tuesday before he can see her.
Spoke to the vet on call, she did not come to see her but based on my description has advised hot compresses (I am also using epsom salts in these) and DMSO.
Anything else I can do?
Is it OK to ride the horse?


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## glenruby (9 October 2011)

Are you in New york state by any chance? Potomac is not something we see in the UK!

For the moment, DMSO and hot and cold compresses is about all that can be done - it might need antibiotics etc if it doesnt improve within a few days or horses gets a fever.  How long has it been since the catheter was removed - Im guessing a few days at most in which cae i probably wouldnt ride as your horse will still be getting over her Potomac. Out of interest, what PHF signs did she have? Hope she recovers easily.


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## Rooty (11 October 2011)

I'm in Ontario, Canada, and PHF is rare in our parts - my vet has only treated 3 cases and all 3 were on my property. I think we had 10 confirmed cases in the area last year and as far as I know those are the first in over 15 years.
The catheter came out a week ago Sunday, I kept a careful eye on it the first 3 days, noticed the small lump Friday, but it could have started on Thursday as I was thinking if we were going to see any complications we would have already and I was not being as watchful. She had been cleared for light work after the PHF already. She feels good.
I think I am noticing a small improvement, and my regular vet is coming out to see her tonight.


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## Cgd (9 February 2015)

appreciate this is an old thread ! My horse ended up with a clot in jugular vein after a cannula in for a week due to peritonitis.  Face was very swollen and sensitive. Treatment was hot compress and DMSO and elevated feed.  2 weeks later she seems fine in herself but still big swelling behind ear . Particularly fills up after grazing.  We are bring ig her back into work this week .  Spoken to vet so says lets bring her into work and see how it goes.  Anyone have any thoughts?  Will the other veins begin to compensate and the swelling eventually subside ?


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