Immediate, short‐, and long‐term changes in tracheal stent diameter, length, and positioning after placement in dogs with tracheal collapse syndrome

Raske, Matthew; Weisse, Chick; Berent, Allyson; McDougall, Renee; Lamb, Kenneth

doi:10.1111/jvim.15063

Cited by 16 publications

(28 citation statements)

References 23 publications

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“…In this experiment, the entire tracheal circumference was dissected to allow implantation of the prosthesis and was performed non traumatically due to the low invasiveness, preserving important structures and mitigating possible complications [10,17]. Two CCs had RLN involvement (28.57%).…”

Section: Discussionmentioning

confidence: 99%

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

Gomes

Denevitz

Morales

et al. 2021

Acta Scientiae. Vet.

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Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications.Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral lesions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy findings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was 1 (good dissection and visualization), with variance of zero for mediastinoscopy and 0.14 for necropsy. In the mediastinoscopy of one CC, the prosthesis crossed the tracheal bifurcation, involving the posterior vessels of this region, which was confirmed by necropsy. However, the dissection showed no vascular lesions. The integrity of the mediastinum was assessed only by mediastinoscopy. There was no impairment caused by any of the procedures performed. This resulted in a median score of 1 (integrity) with zero variance. When the positioning of the prosthesis was evaluated in relation to the tracheal bifurcation, identical values were obtained by both methods. The median score was 1, with variance of 0.62. No statistical differences were found between the two evaluation methods for the analyzed variables. This demonstrates the strong potential of the proposed evaluation techniques.Discussion: Our results show that the execution of the technique is possible, but some complications may occur. Mediastinoscopy as an evaluation procedure can pose some complications, these considerations are important, but by using technique proposed in this study, these factors are minimized due to the ease of technical implantation of the extraluminal tracheal stent, without the need for several instruments competing in the inflated mediastinal space. We concluded that the technique is viable and a safe method with minimal invasion for investigation and treatment of mediastinal diseases, presenting low impairment of the paratracheal structures, and that mediastinoscopy can be used as a transoperative evaluation method to minimize complications.

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Section: Discussionmentioning

confidence: 99%

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

Gomes

Denevitz

Morales

et al. 2021

Acta Scientiae. Vet.

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“…The CasMin-Twine procedure only requires one cm of ventral dissection to expose cartilage rings, whereas the ELR needs 360° dissection affecting surrounding tracheal structures and an experimented surgeon is required. Moreover, total support of entire trachea is currently recommended (Clarke, 2018; Raske et al, 2018) and with the CasMin-Twine procedures, it is feasible to give support to both extra and intra-thoracic trachea with a single spiral stent without having complications compared to ELR.…”

Section: Discussionmentioning

confidence: 99%

“…In human patients, the Food and Drug Administration (FDA) prohibited every kind of metallic stents for benign airway disease due to the major complications and no recovery possibility of the devices (Chung et al, 2011; Saito & Imamura, 2005; Folch & Keyes, 1998; Onofre et al, 2008). Even though this warning, self-expanding mesh-shaped nitinol stents (SEN) are the best available option for canine tracheal collapse (Weisse et al, 2008; Serrano et al, 2016; Raske et al, 2018; Weisse et al, 2019). Silicon stents are not recommended in veterinary practice due to the high migration and excessive mucus accumulation already described (Onofre et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…There is a small number of published studies which describe the stenting procedure in canine tracheal collapse, and most of them reported similar complications: granuloma formation, stent migration, severe mucus accumulation and stent fracture (Rosenheck et al, 2017; Serrano et al, 2016; Moritz, Schneider & Bauer, 2004; Raske et al, 2018; Weisse et al, 2019; Saito & Imamura, 2005). A critical key point in this procedure is to choose precise stent sizing and handicraft/surgical skills (Clarke, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…The current recommendation is to overestimate stent diameter between 10–20% to reduce migration, the measurement of tracheal diameter is essential, but also a complex procedure (Sura & Krahwinkel, 2008; Rosenheck et al, 2017; Raske et al, 2018; Johnson, Singh & Pollard, 2015). In our study with CasMin-Twine, it is not necessary to overestimate the diameter of the device because the prosthesis is fixed by suture knot and not by radial force.…”

Section: Discussionmentioning

confidence: 99%

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New tracheal stainless steel stent pilot study: twelve month follow-up in a rabbit model

López-Mínguez

Serrano‐Casorran

Guirola

et al. 2019

PeerJ

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Background Canine tracheal collapse is a complex airway pathology without promising treatment results. Currently nitinol stents are the best surgical option; however, some professionals are doubting if stent placement is the best option due to the associated complications. Objective Determine the technical feasibility, safety, and long-term follow-up after the implantation of a new tracheal stent designed for canine tracheal collapse. Methods Thirteen healthy, adult female New Zealander rabbits were involved in this pilot study.A new intra-tracheal device (Reference number 902711 patent registered as CasMin-Twine) was implanted in ten animals. Deployment was performed under general anesthesia, making a puncture incision via a 21 Gauge needle in the intra-tracheal space where the stent was introduced with a screwing process. The device was fixed to the tracheal wall with a non-absorbable suture. Computerized Tomography (CT) and an endoscopy to study structural abnormalities were performed after 30, 90 and 365 days after stent placement. Results Technical and clinical success was 100%. There was no significant change in behavior or respiratory disorders. CT studies showed no significant alterations. After the 30 days, 60% of the animals showed partial endothelization in the endoscopy study, and only one animal still presented partial endothelization after 12 months. Mucus accumulation was only present in 40% of cases and classified as low, without respiratory consequences. Only one animal presented a single granuloma at caudal stent tip. Conclusions This new tracheal stent (CasMin-Twine) is an effective and safe procedure with promising results, and also shows the possibility of removing the device after endothelization has been produced. New studies should be carried out to evaluate the effectiveness in patients with tracheomalacia. Clinical Significance/Impact This new product can give veterinarians a new option of treatment for this complicated pathology. Minimizing specific equipment for its deployment, CasMin-Twine will be more accessible for all professionals.

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Tracheal Surgery

MacPhail¹

2023

Small Animal Soft Tissue Surgery

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Immediate, short‐, and long‐term changes in tracheal stent diameter, length, and positioning after placement in dogs with tracheal collapse syndrome

Cited by 16 publications

References 23 publications

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

New tracheal stainless steel stent pilot study: twelve month follow-up in a rabbit model

Tracheal Surgery

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