Management of Advanced Tracheal Collapse in Dogs Using Intraluminal Self-Expanding Biliary Wallstents

Abstract

Twenty-four client-owned dogs with tracheal collapse refractory to conventional treatment underwent management with an intraluminal self-expanding stainless-steel endoprosthesis (Wallstent). Initial improvement of clinical signs was observed in 95.8% of the dogs. Two dogs (8.3%) died within a median interval of 6 days after stent implantation due to incorrect placement and size of the stent and emphysema, respectively. A dry cough occurred temporarily in most of the patients. One dog each (4.1%) suffered mild transient tracheal hemorrhage and pneumomediastinum. The results showed that the initial survival rate of intraluminal stabilization was comparable with surgical implantation of extratracheal prostheses. Clinical reevaluation was performed in 18 dogs within a median interval of 68 days after treatment. Of the dogs treated, 30.4% were reported to be asymptomatic after stent implantation, 60.9% improved markedly, and 4.3% remained symptomatic. In all patients undergoing endoscopy, the Wallstents were almost completely covered with tracheal epithelium. A median shortening of 27.3% of the endoprosthesis within a median interval of 175 days after stent implantation in 15 of 18 dogs was noted. The shortening was associated with clinical signs in 2 patients. In 5 dogs, steroid-responsive granuloma formation resulted in a severe reduction of the tracheal lumen in 3 patients. The results suggest that implantation of Wallstents was minimally invasive and provided stabilization of collapsed thoracic tracheal portions in addition to the cervical part of the trachea. This minimally invasive method for the management of severe tracheal collapse therefore provides an attractive alternative to surgery.

Tracheal Collapse in the dog: step by step from pathophysiology to management

“…Μάλιστα, το ποσοστό συνύπαρξης των δύο νοσημάτων κυμαίνεται από MEDICAL SOCIETY 2010,61(3) ΙΚΗΣ ΕΤΑΙΡΕΙΑΣ 2010 258 12,5% (Moritz et al 2004) έως 19,4% (Macready et al 2007). Στην Ελλάδα το ποσοστό φαίνεται ότι είναι υψηλότερο και προσδιορίζεται στο 35% του συνόλου των περιστατικών με ΣΤΤ, κάτι που ίσως οφείλεται στη μεγαλύτερη ηλικία διάγνωσης του νοσήματος στη χώρα μας, 9 χρόνια έναντι 4 -7,5 χρόνια σε άλλες χώρες (Buback et al 1996, Payne et al 2006, Pardali 2008.…”

“…Βασικά κριτήρια στην επι λογή των περιστατικών που υποβάλλονται στην τεχνική αυτή είναι η παρουσία εκτεταμένης ΣΤΤ στη θωρακική ή/και στην τραχηλική μοίρα της τραχείας, η αποτυχία επαρκούς ανταπόκρισης στη φαρμακευτική αγωγή και η πιθανή συνύπαρξη σύμπτωσης των τοιχωμάτων των στελεχιαίων βρόγχων (Gellasch et al 2002, Moritz et al 2004, Payne et al 2006. Στο εμπόριο κυκλοφο ρούν δύο μεγάλες κατηγορίες ενδοαυλικώς διατεινό μενων προσθέτων: α) τα μεταλλικά, που διατείνονται με τη βοήθεια ασκού (Palmaz, Strecker) και β) τα μεταλλικά αυτοδιατεινόμενα (Wallstent, Nitinol, Dia-MEDICAL SOCIETY 2010,61(3) ΙΚΗΣ ΕΤΑΙΡΕΙΑΣ 2010 Δ. ΠΑΡΔΑΛΗ, Α. Κ. ΑΔΑΜΑΜΑ-ΜΩΡΑίΤΟΥ mond Ultraflex, Z-stent) (Payne et al 2006, Kim et al 2008.…”

Conservative Management of Canine Tracheal Collapse with Stanozolol: A Double Blinded, Placebo Control Clinical Trial

“…Various surgical techniques have been described for the management of TC, but unfortunately not all candidates improve by surgical intervention (I). Intraluminal expandable stents are considered promising but, both in humans and dogs, they lack long-term evaluation (14,27). However, there is no specific medical treatment available to improve cartilage metabolism or structure (3,10).…”

Use of a double-wire woven uncovered nitinol stent for the treatment of refractory tracheal collapse in a dog: a case report

“…Tracheal collapse is a progressive disorder of the airway characterised by laxity of the dorsal tracheal membrane, chondromalacia and collapse of cartilage rings in middle-aged small and toy dogs, resulting in airway obstruction (Gellasch et al 2002;Moritz et al 2004;Sun et al 2008). Collapsed trachea initiates 'honking' cough, which can lead to life-threatening conditions including severe respiratory distress, cyanosis, and syncope (Fossum 2007;Durant et al 2012).…”

“…The primary goal of surgical therapy for tracheal collapse is to restore normal tracheal lumen by supporting the dorsal tracheal membrane and cartilage rings without disruption of blood and nerve supply to the trachea (Nelson 2003;Fossum 2007;Tinga et al 2015). Various surgical techniques have been described, including plication of the dorsal tracheal membrane, tracheal ring chondrotomy, extraluminal prostheses and intraluminal stents (Buback et al 1996;Ayres and Holmberg 1999;Moritz et al 2004). Compared with conventional surgical techniques, intraluminal tracheal stenting has many advantages, including minimal invasiveness, immediate improvement in clinical signs and shorter anaesthetic, surgery and recovery times; however, fractured stents have been described as a major complication (Mittleman et al 2004;Woo et al 2007;Sun et al 2008).…”