Intravenous Regional Limb Perfusion in Equine Medicine
Summary
Intravenous regional limb perfusion (IVRLP) is a targeted delivery technique widely used in equine practice to achieve high local concentrations of antimicrobial agents in distal limb structures while minimising systemic exposure. With the application of a proximal tourniquet to occlude venous outflow and the infusion of antibiotic-laden perfusate into a distal vein, clinicians can rapidly attain synovial concentrations many times above the minimum inhibitory concentration of common pathogens. This method is integral in the management of septic synovitis, tendon sheath infections and bursal sepsis, offering an efficacious alternative to systemic therapy, particularly in horses where high systemic doses would risk toxicity or fail to penetrate avascular tissues. Recent refinements have focused on tourniquet design, perfusate volume and the addition of local analgesia to enhance drug distribution and minimise discomfort. Pharmacokinetic studies have further elucidated peak concentration (Cmax) and time to peak (Tmax) parameters, guiding dosage and duration of occlusion. In conjunction with synovial lavage and surgical debridement, IVRLP plays a central role in limb salvage, improving survival rates and accelerating return to function in athletic and working horses worldwide.
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Intravenous Regional Limb Perfusion in Equine Medicine publication trend
The graph below shows the total number of articles in intravenous regional limb perfusion in equine medicine across all publications each year (not limited to Nature Index journals).
Technical terms
Intravenous regional limb perfusion (IVRLP): A technique for locally administering drugs into the distal limb circulation under tourniquet occlusion to enhance tissue concentrations.
Tourniquet: A device applied proximal to the infusion site to restrict venous return and maintain high local drug levels during perfusion.
Minimum inhibitory concentration (MIC): The lowest concentration of an antimicrobial agent needed to prevent visible growth of a microorganism in vitro.
Perfusate: The fluid mixture containing dissolved antimicrobial agents infused into the limb vein during regional perfusion.
Synovial fluid: The lubricating liquid within joint spaces and tendon sheaths, sampled to assess local drug concentrations and infection status.
References
- Effects of regional limb perfusion technique on concentrations of antibiotic achieved at the target site: A meta-analysis. PLOS ONE (2022).
- Synovial Concentration of Trimethoprim-Sulphadiazine Following Regional Limb Perfusion in Standing Horses. Animals (2021).
- Meropenem Administered via Intravenous Regional Limb Perfusion for Orthopedic Sepsis in Horses: A Clinical Retrospective Study. Frontiers in Veterinary Science (2021).
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