Difference between revisions of "Thrombosis"

Latest revision as of 22:40, 15 June 2016

Introduction

Pulmonary artery thrombus. Courtesy of A. Jefferies

Nasal thrombosis (dog). Courtesy of T. Scase

A thrombus is a localized or generalized intravascular or intracardiac blood clot. Thrombosis is the method of formation of a thrombus. Thrombi may occur in any vasculature in the body and form as the result of trauma or pathological processes affecting the blood vessel endothelium or disturbances to blood flow and/or blood composition. Some diseases such as infective endocarditis and heart worm increase the risk of thrombi formation.

It may occur due to endothelial injury, altered blood flow e.g. abnormal stasis or hypercoagulability.

Thrombosis is often associated with other disease processes such as disseminated intravascular coagulation (DIC). In cats with hypertrophic cardiomyopathy, thrombosis often causes posterior paralysis in these animals, as it lodges in the branching of the abdominal aorta.

Spontaneous venous thrombosis is rare, but can be seen in cattle with traumatic reticulo-peritonitis in the caudal vena cava.

Types

There are many different types of thrombosis.

Arterial thrombosis is common in man, but it is uncommon in domestic animals; in man it is associated with atherosclerotic vascular disease. When they do occur in animals, arterial thrombi are usually small lesions but these may be sited strategically, thereby causing problems.

Arteriosclerosis is seen in aged dogs and horses affecting the coronary artery and other major arteries.

Verminous arteritis may occur with or without aneurysm and is seen in horses as a result of Strongylus vulgaris infestation. It affects the root of cranial mesenteric artery, renal artery and aorta as a consequence of larval migration in the vessel walls.

Cardiac thrombosis is usually valvular, but can occasionally be mural. In farm animals, and rarely in the horse, infective/inflammatory thrombosis occurs subsequent to endocarditis. In dogs and horses, cardiac thrombosis is generally of degenerative/non-infectious cause; endocarditis may occur, though uncommonly.

Venous thrombosis is a fairly common type of thrombus in the veterinary species because veins are relatively thin-walled and are therefore more susceptible to distortion, inflammatory damage and iatrogenic venepuncture damage. Also,veins have relatively slower blood flow rates allowing cell aggregates to persist more readily. Most venous thrombosis in domestic animals results from extension of inflammatory reactions, erosion/disruption caused by malignant tumours, pressure from adjacent space-occupying masses or venepuncture damage.

Capillary thromboses are microthrombi that are only appreciable histologically. Their formation may be localised and associated with acute local inflammation or generalised. Localised microthrombi are rarely significant unless they are strategically sited. Generalised microthrombi may be seen in terminal diseases as a reflection of vascular failure, and are often associated with shock syndromes as part of disseminated intravascular coagulation. Clinically, generalised capillary thrombosis is highly significant.

Signalment

Can occur in any specie of animal, but is most commonly described in dogs and cats.

Clinical Signs

Signs depend on the area affected and the size of the vessel blocked. There will always be poor perfusion below the affected area, or malfunction and necrosis of the affected organs. The area affected will often appear pale, cold, have poor perfusion and be painful to touch.

Diagnosis

Nasal thrombosis (dog). Courtesy of T. Scase

History and clinical signs can be indicative of the condition. On blood tests, one may see abnormalities associated with lack of blood perfusion in pathological conditions that can cause the thrombosis.

Ultrasonography may show blood stasis and may also demonstrate the presence of a thrombus.

Angiography may show lack of opacity in the affected region.

On microscopic examination, the thrombus appears as a layered mass which is attached to the vessel wall. The composition consists of red blood cells, neutrophils and platelets bound together by fibrin. Thrombi take different appearance depending on whether they are arterial or venous. Arterial thrombi tend to be pale and have a tail in the direction of blood flow. The high rate of blood flow sweeps red cells away - the thrombus is composed of mainly white cells, platelets and fibrin which are left behind. Venous thrombi tend to be a darker red. The slow blood flow allows the clot to form quicker which is loosely arranged and contains many red blood cells.

Treatment

The mainstay of treatment is to diagnose and treat the underlying problem.

It is important to give pain relief and IV Fluids as palliative care. The use of an anticoagulant such as heparin for short-term treatment or aspirin for long-term treatment should be considered.

Prognosis

DIC thrombus. Courtesy of A. Jefferies

Prognosis depends upon the underlying condition.

If the animal survives the immediate effects of a thrombus, the thrombus may evolve in one of the following ways:

The thrombus may gradually enlarge and eventually cause total obstruction of a vessel.
The thrombus may be completely removed by fibrinolytic activity; fibrinolysis is a very active process and clots are usually removed within a few days of formation provided that blood flow is sufficient. An occlusive thrombus may prevent the necessary enzymes from reaching the clot but contraction of fresh clots under the influence of thrombasthenin (released by platelets) may provide a slit-like channel beside the thrombus that permits the blood flow to restart and completely dissolve the clot.
Organisation; a thrombus acts as a foreign body, causing an inflammatory response in the underlying blood vessel or heart wall. The external surface of the thrombus then quickly becomes covered by endothelium and is excluded from the clotting mechanism. Neutrophils invade the mass and may reduce the centre. Occasionally, subsequent invasion by bacteria may lead to purulent inflammation. Normally, fibroblasts and capillary buds follow the neutrophils into the thrombus and a fibrous vascularised connective tissue forms. Capillaries channels anastomose to produce vessels that traverse the thrombus and re-establish blood flow - this is known as canalisation of a thrombus. Fibrous tissue matures and contracts, eventually causing the thrombus to become incorporated into the vessel wall as a fibrous lump. A piece of the thrombus may break off and form an embolus.

Also see: Thromboembolism.

References

Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company

Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2) W.B. Saunders Company

Fossum, T. W. et. al. (2007) Small Animal Surgery (Third Edition) Mosby Elsevier

Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition) Merial

Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevie

Error in widget FBRecommend: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6639de9a686be9_16325899

Error in widget google+: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6639de9a6c3f86_48873321

Error in widget TwitterTweet: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6639de9a6f79c4_78479047

WikiVet^® Introduction - Help WikiVet - Report a Problem

Thrombosis Learning Resources
Vetstream To reach the Vetstream content, please select	Canis, Felis, Lapis or Equis

@@ Line 1: / Line 1: @@
-[[Image:Pulmonary artery thrombus.jpg|right|thumb|225px|<small><center>'''Pulmonary artery thrombus'''. Courtesy of A. Jefferies</center></small>]]
+{{OpenPagesTop}}
-==Introduction==
+== Introduction ==
-[[Image:sarcoma embolus.jpg|right|thumb|200px|<small><center>'''Sarcoma embolus (dog)'''. Courtesy of T. Scase</center></small>]]
+[[Image:Pulmonary artery thrombus.jpg|thumb|right|200px|<small><center><b>Pulmonary artery thrombus</b>. Courtesy of A. Jefferies</center></small>]]
-'''''Thrombosis''''' may be due to:
+[[Image:Thrombosis dog nose 2.jpg|thumb|right|200px|<small><center><b>Nasal thrombosis (dog)</b>. Courtesy of T. Scase</center></small>]]
-*Endothelial injury.
+A thrombus is a localized or generalized intravascular or intracardiac blood clot. Thrombosis is the method of formation of a thrombus. Thrombi may occur in any vasculature in the body and form as the result of trauma or pathological processes affecting the blood vessel endothelium or disturbances to blood flow and/or blood composition. Some diseases such as infective [[endocarditis]] and [[Dirofilaria immitis|heart worm]] increase the risk of thrombi formation.
-*Altered blood flow E.g. abnormal stasis.
-*Hypercoagulability.
-Often associated with other disease processes such as [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation (DIC)]].
+It may occur due to endothelial injury, altered blood flow e.g. abnormal stasis or hypercoagulability.
-Commonly see [[Atrial_Thrombosis|posterior paralysis]] of cats with cardiomyopathy.
+Thrombosis is often associated with other disease processes such as [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation (DIC)]]. In cats with [[Hypertrophic Cardiomyopathy|hypertrophic cardiomyopathy]], thrombosis often causes [[Atrial Thrombosis|posterior paralysis]] in these animals, as it lodges in the branching of the abdominal aorta.
-Spontaneous venous thrombosis is rare.  Seen in cattle with traumatic reticulo-peritonitis in the caudal vena cava.
+Spontaneous venous thrombosis is rare, but can be seen in cattle with [[Traumatic Reticulitis|traumatic reticulo-peritonitis]] in the caudal vena cava.
-===Description===
+==Types==
-Thrombosis is a localized or generalized intravascular clot formation.  Thrombi form as the result of trauma or pathological processes affecting the blood vessel endothelium or disturbances to blood flow and/or blood composition.  Some diseases such as infective endocarditis and heart worm increase the risk of thrombi formation.
+There are many different types of thrombosis.
-===Diagnosis===
+'''Arterial thrombosis''' is common in man, but it is uncommon in domestic animals; in man it is associated with atherosclerotic vascular disease. When they do occur in animals, arterial thrombi are usually small lesions but these may be sited strategically, thereby causing problems.
-====History & Clinical Signs====
-*Signs depend on the area affected and the size of the blocked vessel.
-*Poor perfusion below affected area.
-*Malfunction and necrosis of affected organs
-====Laboratory Findings====
+'''[[Arteriosclerosis]]''' is seen in aged dogs and horses affecting the coronary artery and other major arteries.
-Abnormalities associated with lack of blood perfusion and/or pathological conditions.
-====Ultrasonography====
+'''[[Intestinal Arterial Thromboembolism|Verminous arteritis]] may occur with or without [[aneurysm]] and is seen in horses as a result of ''[[Strongylus vulgaris]]'' infestation. It affects the root of cranial mesenteric artery, renal artery and aorta as a consequence of larval migration in the vessel walls.
-*Blood stasis
-*Visualization of a thrombus
-====Angiography====
+'''Cardiac thrombosis''' is usually valvular, but can occasionally be mural. In farm animals, and rarely in the horse, infective/inflammatory thrombosis occurs subsequent to [[endocarditis]]. In dogs and horses, cardiac thrombosis is generally of degenerative/non-infectious cause; endocarditis may occur, though uncommonly.
-*May show lack of opacity in affected region
-==Treatment==
+'''Venous thrombosis''' is a fairly common type of thrombus in the veterinary species because veins are relatively thin-walled and are therefore more susceptible to distortion, inflammatory damage and iatrogenic venepuncture damage. Also,veins have relatively slower blood flow rates allowing cell aggregates to persist more readily. Most venous thrombosis in domestic animals results from extension of inflammatory reactions, erosion/disruption caused by malignant tumours, pressure from adjacent space-occupying masses or venepuncture damage.
-*Treat underlying problem
-*Give IV Fluids
-*Use an anticoagulant (Heparin for short term treatment, Aspirin for long term treatment)
-==Prognosis==
+'''Capillary thromboses''' are microthrombi that are only appreciable histologically. Their formation may be localised and associated with acute local inflammation or generalised. Localised microthrombi are rarely significant unless they are strategically sited. Generalised microthrombi may be seen in terminal diseases as a reflection of vascular failure, and are often associated with [[Shock|shock syndromes]] as part of [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation]]. Clinically, generalised capillary thrombosis is highly significant.
-Prognosis depends upon the underlying condition.
-==Pathophysiology==
+== Signalment ==
-===Terminology===
-* A thrombus is a solid blood clot that forms within the vessels or heart during life.
-* The process of thrombus formation is known as thrombosis.
-* Thrombii may occur anywhere within the cardiovascular system.
-===Thrombosis formation===
+Can occur in any specie of animal, but is most commonly described in dogs and cats.
-[[Image:DIC thrombus.jpg|right|thumb|200px|<small><center>'''DIC thrombus'''. Courtesy of A. Jefferies</center></small>]]
-The process usually begins with platelets becoming sticky. They adhere to each other and to the endothelium. This increased "stickiness" is induced by contact with:
-* Collagen
-* Basement membrane
-* Damaged endothelial cells
-* Bacteria
-===Microscopic Appearance of a Thrombus===
+== Clinical Signs ==
-A thrombus is a layered mass which is attached to the vessel wall. The composition consists of red blood cells, [[[[Neutrophils|Neutrophils]] - WikiBlood|neutrophils]] and platelets bound together by fibrin.
-Thrombi take different appareance depending on whether they are arterial or venous:
+Signs depend on the area affected and the size of the vessel blocked. There will always be poor perfusion below the affected area, or malfunction and necrosis of the affected organs. The area affected will often appear pale, cold, have poor perfusion and be painful to touch.
-* Arterial thrombi tend to be pale and have a tail in the direction of blood flow.  The high rate of blood flow sweeps red cells away - the thrombus is composed of mainly white cells, platelets and fibrin which are left behind.
-* Venous thrombi tend to be a darker red. The slow blood flow allows the clot to form quicker which is loosely arranged and contains many red blood cells.
-==Causes of Thrombosis==
+== Diagnosis ==
-Thrombosis is caused by any condition that allows platelets to adhere to the endothelial wall, including:
+[[Image:Thrombosis dog nose.jpg|thumb|right|200px|<small><center><b>Nasal thrombosis (dog)</b>. Courtesy of T. Scase</center></small>]]
-*Damage to the vessel wall - when there is damage of the overlying endothelium, collagen is exposed and platelets will attach to this. The blood clotting process will occur, giving formation of an intraluminal blood clot. The process  of formation occurs in phases giving a cross section of the clot a laminated appearance.
+History and clinical signs can be indicative of the condition. On blood tests, one may see abnormalities associated with lack of blood perfusion in pathological conditions that can cause the thrombosis.
-Vessel walls may be damaged in several ways:
+Ultrasonography may show blood stasis and may also demonstrate the presence of a thrombus.
-#Trauma
-#Localisation by colonies of bacteria
-#Viral infection of endothelial cells
-#Migration of parasites.
-#Repeated puncture of the jugular vein is a common cause of serious or fatal thrombosis.
-*Changes in normal blood flow, including stasis, turbulence, and changes in blod composition.
+Angiography may show lack of opacity in the affected region.
-Stasis prevents coaglation factors being cleared by the liver and reticuloendothelial system.
+On microscopic examination, the thrombus appears as a layered mass which is attached to the vessel wall. The composition consists of [[Red Blood Cell|red blood cells]], [[neutrophils]] and [[platelets]] bound together by fibrin. Thrombi take different appearance depending on whether they are arterial or venous. '''Arterial thrombi''' tend to be '''pale''' and have a tail in the direction of blood flow. The high rate of blood flow sweeps red cells away - the thrombus is composed of mainly white cells, platelets and fibrin which are left behind. '''Venous thrombi''' tend to be a '''darker red'''. The slow blood flow allows the clot to form quicker which is loosely arranged and contains many red blood cells.
-Coagulation factors build up, leading to clot formation which quickly enlarges to fill the lumen. When stasis occurs in a vein, the thrombus forms behind the valve cusps.
-Turbulence disrupts the laminar flow and may even damage the endothelium, allowing platelets to come into contact with the endothelial wall. Thrombi tend to form at arterial branches and venous junctions where there are eddy currents and local stasis.
+== Treatment ==
-Altered blood composition which can induce thrombosis includes an increase in the number and adhesiveness of platelets, or in plasma fibrin and clotting factors, resulting in a hypercoagulateable state. There may also be a decrease in the activity of the fibrinolyltic system. This may be caused by surgical or traumatic shock, or inflammation with toxaemia.
+The mainstay of treatment is to diagnose and treat the underlying problem.
-==Types of Thrombosis==
+It is important to give pain relief and [[:Category:Fluid Therapy|IV Fluids]] as palliative care. The use of an anticoagulant such as heparin for short-term treatment or aspirin for long-term treatment should be considered.
-===Arterial Thrombosis===
-Although this is common in man, it is uncommon in domestic animals; in man it is associated with atherosclerotic vascular disease. When they do occur in animals, arterial thrombi are usually small lesions but these may be sited strategically, thereby causing problems.
-====Arteriosclerosis====
+== Prognosis ==
-Seen in aged dogs and horses affecting the coronary artery and other major arteries.
+[[Image:DIC thrombus.jpg|thumb|right|200px|<small><center><b>DIC thrombus</b>. Courtesy of A. Jefferies</center></small>]]
+Prognosis depends upon the underlying condition.
-====Verminous arteritis====
+If the animal survives the immediate effects of a thrombus, the thrombus may evolve in one of the following ways:
-May occur with or without aneurysm and is seen in horses as a result of ''Strongylus vulgaris'' infestation. Affects the root of cranial mesenteric artery, renal artery and aorta as a consequence of larval migration in the vessel walls.
-====Iliac thrombosis====
+# The thrombus may gradually enlarge and eventually cause total obstruction of a vessel.
-Seen in cats in the UK, and often referred to as a "saddle embolus", this condition is associated with cardio-myopathy and atrial thrombosis.
+# The thrombus may be completely removed by fibrinolytic activity; fibrinolysis is a very active process and clots are usually removed within a few days of formation provided that blood flow is sufficient. An occlusive thrombus may prevent the necessary enzymes from reaching the clot but contraction of fresh clots under the influence of thrombasthenin (released by platelets) may provide a slit-like channel beside the thrombus that permits the blood flow to restart and completely dissolve the clot.
+# Organisation; a thrombus acts as a foreign body, causing an inflammatory response in the underlying blood vessel or heart wall. The external surface of the thrombus then quickly becomes covered by endothelium and is excluded from the clotting mechanism. Neutrophils invade the mass and may reduce the centre. Occasionally, subsequent invasion by bacteria may lead to purulent inflammation. Normally, fibroblasts and capillary buds follow the neutrophils into the thrombus and a fibrous vascularised connective tissue forms. Capillaries channels anastomose to produce vessels that traverse the thrombus and re-establish blood flow - this is known as '''canalisation''' of a thrombus. Fibrous tissue matures and contracts, eventually causing the thrombus to become incorporated into the vessel wall as a fibrous lump. A piece of the thrombus may break off and form an [[Embolism|embolus]].
-===Cardiac Thrombosis===
+<b>Also see: [[Thromboembolism]].</b>
-Cardiac thrombosis is usually valvular, but can occasionally be mural.
-==Species specific Thrombi==
+== References ==
-===Farm Species===
-In farm animals, and rarely in the horse, infective/ inflammatory thrombosis occurs subsequent to endocarditis.
-===Dogs and Horse===
+Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 '''(Fifth Edition)'' W.B. Saunders Company''
-[[Image:thrombosis dog nose.jpg|right|thumb|200px|<small><center>'''Nasal thrombosis (dog)'''. Courtesy of T. Scase</center></small>]]
-Cardiac thrombosis is generally of degenerative/ non-infectious cause; endocarditis may occur, though uncommonly. There are important effects of cardiac thrombosis:
-# Distortion of valve cusps leads to mechanical effects which cause ineffective closure (incompetence), and distortion and enlargement of the valves by the thrombus mass causes narrowing of the valve outflow (stenosis). These effects lead to a progressive inefficiency of cardiac pumping and give rise to [[Venous Congestion and Hyperaemia - Pathology#Generalised (Systemic) Venous Congestion|general venous congestion]], [[Oedema - Pathology|oedema]] and circulatory failure.
-# Emboli can be disseminated from the thrombus mass. If the lesion is on the left side of the heart, emboli are disseminated systemically and become trapped in the capilarry beds, e.g. of the kidney and spleen. The blockage leads to local ischaemic necrosis. If the lesion is on the right side of the heart, there is pulmonary dissemination.
-[[Image:thrombosis dog nose 2.jpg|right|thumb|200px|<small><center>'''Nasal thrombosis (dog)'''. Courtesy of T. Scase</center></small>]]
-====Atrial Thrombosis====
-These are uncommon, but are seen rarely in cats and dogs as a result of stasis in atrial appendages.
-====Venous Thrombosis====
+Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine '''(6th edition, volume 2) ''W.B. Saunders Company''
-Thrombus formation in the venous system occurs most commonly as the result of trauma, venous catheterisation, or neoplastic conditions.
-Obstruction of the affected area or embolisation of the thrombus to distant areas results in a variety of clinical signs.  As could be expected, the location of the insult determines the type of presenting signs.  For example, pulmonary emboli cause respiratory problems while portal vein thrombi result in ascites and the possible development of hepatic encephalopathy or portosystemic shunting.
+Fossum, T. W. et. al. (2007) '''Small Animal Surgery '''(Third Edition) ''Mosby Elsevier''
-* Venous thrombosis is a fairly common type of thrombus in the veterinary species.
+Merck &amp; Co (2008) '''The Merck Veterinary Manual '''(Eighth Edition)'' Merial''
-** This is because:
-**# Veins are relatively thin-walled.
-**#* Are therefore more susceptible to distortion, inflammatory damage and iatrogenic vene puncture damage.
-**# Veins have relatively slower blood flow rates.
-**#* Cell aggregates tend to persist more readily.
-* Most venous thrombosis in domestic animals results from :
-** Extension of inflammatory reactions.
-** Erosion/disruption caused by malignant tumours.
-** Pressure from adjacent space-occupying masses.
-** Vene puncture damage.
-===Capillary Thrombosis===
+Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine '''(Fourth Edition)'' Mosby Elsevie''
-* These are microthrombi.
-** Only appreciable histologically.
-* Formation may be:
-** Localised
-*** Associated  with acute local inflammation.
-*** Not very significant unless strategically sited.
-**Generalised
-*** May be seen in terminal disease as a reflection of vascular failure.
-*** Often associated with shock syndromes as part of [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation]].
-*** Clinically very significant.
-==Evolution of a Thrombus==
-* If the animal survives the immediate effects of a thrombus, the thrombus may evolve in one of the following ways:
+{{review}}
-# The thrombus may gradually '''enlarge''' and eventually cause total '''obstruction''' of a vessel.
-# The thrombus may be completely '''removed by fibrinolytic activity'''.
-#* Fibrinolysis is a very active process - clots are usually removed within a few days of formation.
-#* Blood flow is crucial to the process of fibrinolysis.
-#** An occlusive thrombus may prevent the necessary enzymes from reaching the clot.
-#* To overcome occlusion, contraction of fresh clots under the influence of thrombasthenin (released by platelets) forms a slit-like channel beside the thrombus.
-#** The blood that then flows past may completely dissolve the clot.
-# '''Organisation'''
-#* A thrombus acts as a foreign body, causing an inflammatory response in the underlying blood vessel or heart wall.
-#* The external surface of the thrombus quickly becomes covered by endothelium.
-#** Is excluded from the clotting mechanism.
-#* [[Neutrophils|Neutrophils]] invade the mass and may digest the centre.
-#** Occasionally, subsequent invasion by bacteria may lead to to purulent inflammation.
-#** Normally, fibroblasts and capillary buds follow the neutrophils into the thrombus and a fibrous vascularised connective tissue forms.
-#*** Capillaries channels anastomose to produce vessels that traverse the thrombus and re-establish blood flow.
-#**** This is known as canalisation of a thrombus.
-#***  Fibrous tissue matures and contracts, eventually causing the thrombus to become incorporated into the vessel wall as a fibrous lump.
-# A piece of the thrombus may '''break off and form an embolus'''.
+{{OpenPages}}
-[[Category:Arterial_Pathology]][[Category:Cardiovascular_System_-_Vascular_Pathology]][[Category:To_Do_-_Cardiovascular]]
+{{Learning |Vetstream = [https://www.vetstream.com/equis/Content/Disease/dis00893.asp Aortoiliac Thrombosis]}}
-[[Category:Venous_Pathology]]
+[[Category:Cardiovascular_System_-_Vascular_Pathology]]
+[[Category:Expert_Review]]
+[[Category:Venous_Pathology]]
+[[Category:Vascular_Diseases_-_Dog]]
+[[Category:Vascular_Diseases_-_Cat]]
+[[Category:Vascular_Diseases_-_Horse]]
+[[Category:Circulatory_Disorders_-_Pathology]]
+[[Category:Cardiology Section]]