Pearl was a 6 year old SF Boxer transferred to our Internal Medicine (Dr. Adam Shoelson) service after being admitted for unilateral epistaxis and collapse. After a blood transfusion a nasal CT and rhinoscopy were performed, which provided the diagnosis of destructive fungal rhinitis (see the Internal Medicine article for more information on Pearl’s case).

Pearl represented to our emergency service a few days after her procedure for another episode of anemia-induced collapse. The severity of the nasal vasculature destruction was causing life threatening hemorrhage. Dr. Gianetto from our surgery service performed a unilateral left carotid artery ligation under general anesthesia.

Since then, Pearl has continued treatment for her fungal rhinitis and has had no further collapse episodes. She has continued to do great as of the publication of this article under the care of our Internal Medicine service.

Clinically relevant facts:

• Carotid artery ligation should be considered in dogs with clinically significant oral or maxillo-facial hemorrhage, where traditional hemostatic methods are unsuccessful or unfeasible.
• Complications for this procedure in dogs are not well documented, but in general include retinal damage and cerebral edema.
• Anatomically dogs have sufficient arterio-arterial collateral blood supply from the vertebral arteries, and can therefore tolerate bilateral carotid artery ligation if needed.
• Bilateral carotid artery ligation may predispose canine patients to strokes (ischemic events). No recommendations currently exist in veterinary medicine on whether anticoagulant therapies are indicated for ischemic event prevention.
• We have provided a case report for a 3 yr MI Border Collie who underwent life-saving bilateral carotid artery ligation to address uncontrollable oral and nasal hemorrhage. These signs occurred after an episode of stick chewing. 5 days post-surgery this patient presented for peracute onset forebrain signs, and was diagnosed with a striate artery infarct via MRI. See MRI pictures from this article.

Authored by: Dr. Landry, DVM, DACVIM, Neurology