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Robin T, Robin E, Le Boedec K. A systematic review and meta-analysis of prevalence of complications after tracheal stenting in dogs. J Vet Intern Med 2024; 38:2034-2044. [PMID: 38822531 PMCID: PMC11256162 DOI: 10.1111/jvim.17117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/07/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Stenting has become popular to treat tracheal collapse in dogs, but complications might arise and negatively affect treatment outcome. OBJECTIVES Determine the overall prevalence of complications of tracheal stenting in dogs. METHODS A bibliographic search was performed of publications from 2000 to 2020. Studies were assessed for quality of evidence and measured prevalence of the 8 most commonly reported complications after tracheal stenting in dogs (stent fracture, stent migration, relapsing collapse, granuloma formation, tracheobronchial infections, and early, late, and clinically relevant late cough). Random effects meta-analyses were used to estimate pooled complications prevalence. RESULTS Fifteen studies met inclusion criteria. Cough (early: 99%; 95% confidence interval [95% CI]: 95%-100%, late: 75%; 95% CI: 63%-85%, and clinically relevant: 52%; 95% CI: 42%-61%), tracheobronchial infections (24%; 95% CI: 14%-35%), and granulomas (20%; 95% CI: 11%-30%) were common after tracheal stenting. Stent fractures (12%; 95% CI: 5%-20%), relapsing collapse (10%; 95% CI: 5%-15%), and stent migration (5%; 95% CI: 1%-9%) were less frequent. Significant heterogeneity among studies was identified for the estimated prevalence of stent fracture, granulomas, infections, and late cough. CONCLUSIONS AND CLINICAL IMPORTANCE Tracheal stenting in dogs is associated with a high risk of coughing and a moderate risk of tracheobronchial infections and granuloma formation. Because most complications will impact a dog's quality of life, owners must be informed that tracheal stenting is a second-line procedure that does not necessarily alleviate the need for medical treatment and frequent follow-up visits. Additional studies are warranted to identify the risk factors of these complications.
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Affiliation(s)
- Thibaud Robin
- Internal Medicine Unit, Centre Hospitalier Vétérinaire Frégis, IVC Evidensia FranceParisFrance
| | - Elisabeth Robin
- Internal Medicine Unit, Centre Hospitalier Vétérinaire Frégis, IVC Evidensia FranceParisFrance
| | - Kevin Le Boedec
- Internal Medicine Unit, Centre Hospitalier Vétérinaire Frégis, IVC Evidensia FranceParisFrance
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Yoon HY, Choi JY. Fatigue analysis of canine tracheal stents using the finite element method. Vet Anim Sci 2024; 23:100341. [PMID: 38389862 PMCID: PMC10882158 DOI: 10.1016/j.vas.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
This study aimed to evaluate fatigue of three stent designs when various forces are applied and perform a comparative analyses. A computer simulation using the finite element method was performed. In particular, we constructed a three-dimensional finite element model of nitinol stents with three designs (S6: single-woven wire, wire diameter: 0.006 inch; D6: double-woven wire, wire diameter: 0.006 inch, and D7: double-woven wire, wire diameter: 0.007 inch) that are used to treat canine tracheal collapse (TC). The stents were subjected to a 200 mmHg compression force, a pure torsion force in a perpendicular direction, and a bending-torsion force combining perpendicular and axial forces. The von Mises stress was calculated to evaluate the extent of stent displacement, and Goodman diagrams were plotted to compare fatigue life cycles. D7 exhibited a longer fatigue life compared to S6 and D6. Under compression, pure torsion, and bending-torsion forces, displacement was the smallest for D7, followed by D6 and S6. Similarly, the fatigue life was the longest for D7, followed by D6 and S6. S6 showed the greatest displacement when subjected to external forces; among stents designed using the same wire, D6 displayed less displacement than S6, and D7 exhibited superior fatigue life when subjected to varying degrees of force. This study showed that the structural stability and fatigue life of stents could be effectively compared using finite element method D7 has the greatest stability and structural rigidity under cyclic load.
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Affiliation(s)
- Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, South Korea
- KU Center for Animal Blood Medical Science, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, South Korea
| | - Jin-Young Choi
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, South Korea
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Graczyk S, Pasławski R, Grzeczka A, Pasławska U, Świeczko-Żurek B, Malisz K, Popat K, Sionkowska A, Golińska P, Rai M. Antimicrobial and Antiproliferative Coatings for Stents in Veterinary Medicine-State of the Art and Perspectives. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6834. [PMID: 37959431 PMCID: PMC10649059 DOI: 10.3390/ma16216834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023]
Abstract
Microbial colonization in veterinary stents poses a significant and concerning issue in veterinary medicine. Over time, these pathogens, particularly bacteria, can colonize the stent surfaces, leading to various complications. Two weeks following the stent insertion procedure, the colonization becomes observable, with the aggressiveness of bacterial growth directly correlating with the duration of stent placement. Such microbial colonization can result in infections and inflammations, compromising the stent's efficacy and, subsequently, the animal patient's overall well-being. Managing and mitigating the impact of these pathogens on veterinary stents is a crucial challenge that veterinarians and researchers are actively addressing to ensure the successful treatment and recovery of their animal patients. In addition, irritation of the tissue in the form of an inserted stent can lead to overgrowth of granulation tissue, leading to the closure of the stent lumen, as is most often the case in the trachea. Such serious complications after stent placement require improvements in the procedures used to date. In this review, antibacterial or antibiofilm strategies for several stents used in veterinary medicine have been discussed based on the current literature and the perspectives have been drawn. Various coating strategies such as coating with hydrogel, antibiotic, or other antimicrobial agents have been reviewed.
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Affiliation(s)
- Szymon Graczyk
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Robert Pasławski
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Arkadiusz Grzeczka
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Urszula Pasławska
- Institute of Veterinary Medicine, Department of Biological and Veterinary Sciences, Nicolaus Copernicus University, Lwowska 1, 87-100 Torun, Poland; (R.P.); (A.G.); (U.P.)
| | - Beata Świeczko-Żurek
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-229 Gdansk, Poland; (B.Ś.-Ż.); (K.M.)
| | - Klaudia Malisz
- Department of Biomaterials Technology, Faculty of Mechanical Engineering and Ship Technology, Gdansk University of Technology, Gabriela Narutowicza 11/12, 80-229 Gdansk, Poland; (B.Ś.-Ż.); (K.M.)
| | - Ketul Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO 80523, USA;
| | - Alina Sionkowska
- Department of Biomaterials and Cosmetic Chemistry, Faculty of Chemistry, Nicolaus Copernicus University in Torun, Gagarina 7, 87-100 Torun, Poland
| | - Patrycja Golińska
- Department of Microbiology, Nicolaus Copernicus University, ul. Lwowska 1, 87-100 Torun, Poland;
| | - Mahendra Rai
- Department of Chemistry, Federal University of Piaui (UFPI), Teresina 64049-550, Brazil;
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Graczyk S, Pasławski R, Grzeczka A, Litwińska L, Jagielski D, Pasławska U. Stents in Veterinary Medicine. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1480. [PMID: 36837110 PMCID: PMC9959717 DOI: 10.3390/ma16041480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Stenting in veterinary medicine has been a rapidly growing method of interventional surgery for several years. This procedure is usually performed in the respiratory and urinary tracts, but there are cases of stenting of blood vessels or gastrointestinal structures. It is based on maintaining the permeability of a given tubular structure, thus allowing the passage of gas or liquid. This procedure is often performed as a first-line treatment in situations where pharmacological agents do not work and as an alternative method, often cheaper than the classically performed ones. There are also cases where stenting is used as a palliative treatment, e.g., to enable defecation in colonic obstruction due to tumour infiltration of the colon wall. Stenting is often a life-saving or comfort-improving procedure for animals, but one should also be aware of possible postoperative complications and be prepared for any adversity. For this reason, this review provides an insight into the current knowledge in veterinary medicine about stenting and the consequences associated with this procedure.
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Kim JH, Choi JY, Yoon HY. Comparison of three different self-expanding metal stents using rabbit models for the treatment of tracheal collapse. Acta Cir Bras 2022; 37:e370502. [PMID: 35976340 PMCID: PMC9377205 DOI: 10.1590/acb370502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose: To identify an optimal self-expandable metallic stent (SEMS) and verify whether a mechanically superior SEMS would result in better clinical outcomes in the treatment of tracheal collapse. Methods: We selected three SEMS (n = 8 each), including an S-type stent with a wire diameter of 0.006 inches (S6) and two D-type stents with wire diameters of 0.006 (D6) and 0.007 inches (D7). Twenty-four New Zealand White rabbits were divided into three equal groups. After the stents were deployed, the clinical signs were recorded daily, and radiographic examinations were performed monthly. All rabbits were euthanized after three months. Results: Two rabbits with S6 stents and one rabbit with a D7 stent died within three months because of stent migration or pneumonia. All rabbits with D6 stents survived for three months. On histological examination, the D6 group had the lowest inflammation score. Conclusions: Both clinically and histopathologically, the results with D-type stents with a wire diameter of 0.006 inches were superior to those of the other groups (p = 0.001). The use of an optimal intraluminal stent may improve the long-term clinical outcomes in the treatment of tracheal collapse in dogs.
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Affiliation(s)
- Ji-Hyun Kim
- DVM., PhD. Konkuk University - College of Veterinary Medicine - Department of Veterinary Surgery - Seoul, South Korea
| | - Jin-Young Choi
- DVM. Konkuk University - College of Veterinary Medicine - Department of Veterinary Surgery - Seoul, South Korea
| | - Hun-Young Yoon
- DVM., PhD. Konkuk University - College of Veterinary Medicine - KU Center for Animal Blood Medical Science - Department of Veterinary Surgery - Seoul, South Korea
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Tanaka M, Uemura A. Self-expanding tracheal stent placement in a cat with primary tracheal collapse. Vet Med Sci 2022; 8:1347-1351. [PMID: 35441501 PMCID: PMC9297796 DOI: 10.1002/vms3.813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 12-year-old mixed-breed spayed female cat presented with dyspnoea, open-mouthed breathing, and cyanosis that was difficult to control with medical pharmacotherapy; the cat was diagnosed with the primary tracheal collapse of the neck and chest regions. The diagnosis was confirmed by dynamic chest radiography, tracheal endoscopy, and computed tomography (CT). Tracheal endoscopy and CT showed dropsy of the dorsal membranous wall over most of the trachea. A self-expanding Nitinol cross-and-hook braided stent was placed along the entire tracheal lumen using surgical X-ray fluoroscopy. Bacterial cultures in the trachea were negative. Dyspnoea disappeared immediately after the endotracheal stent was implanted. Although the long-term prognosis remains under observation, the short- to medium-term prognosis was very good. These results suggest that stenting may be useful in the treatment of primary tracheal collapse in cats.
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Affiliation(s)
- Masashi Tanaka
- Laboratory of Veterinary Surgery, Department of Clinical Veterinary Medicine, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Obihiro-shi, Japan
| | - Akiko Uemura
- Laboratory of Veterinary Surgery, Department of Clinical Veterinary Medicine, Division of Veterinary Research, Obihiro University of Agriculture and Veterinary Medicine, Obihiro-shi, Japan
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7
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Uemura A, Ozai Y, Hamabe L, Yoshida T, Tanaka R. Surgical outcomes in dogs with tracheal collapse treated with a novel cross-and-hook braided endoluminal stent. J Vet Sci 2022; 23:e46. [PMID: 35618319 PMCID: PMC9149497 DOI: 10.4142/jvs.21282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Stenting is an effective treatment option for tracheal collapse in dogs. Cross-braided tracheal stents are currently the norm in veterinary medicine, but cross-and-hook braided stents have recently been adopted in human medicine. We examined whether stents manufactured using this novel braiding technique provided additional advantages for the treatment of tracheal collapse in dogs. Objectives To evaluate the outcomes of cross-and-hook braided stent implantation in the treatment of tracheal collapse in dogs. Methods The medical records of 22 client-owned dogs that underwent luminal placement of cross-and-hook braided Fauna Stents for the treatment of tracheal collapse between January 2018 and July 2021 were examined and data on canine signalment, clinical signs, diagnostic test results, surgical outcomes, and postoperative complications were retrieved and analyzed statistically. Results Twenty-six stents were surgically implanted, with 20 dogs (90.9%) receiving one stent and the remaining two (9.1%) receiving two or more stents. All dogs survived the procedure. The median survival time at a median follow-up of 990 days was 879 days. At the final follow-up examination, loss or mild improvement of cough was observed in all dogs. Conclusions Compared with conventional lumen stents, the cross-and-hook braided Fauna Stent offered a higher survival rate and improved clinical symptoms in all patients. The results of this study suggest that the Fauna Stent may be a promising treatment option for dogs with tracheal collapse.
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Affiliation(s)
- Akiko Uemura
- Division of Veterinary Research, Department of Clinical Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro 080-8555, Japan
| | - Yusuke Ozai
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Lina Hamabe
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Tomohiko Yoshida
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Faculty of Veterinary Medicine, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan
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Violette NP, Weisse C, Berent AC, Lamb KE. Correlations among tracheal dimensions, tracheal stent dimensions, and major complications after endoluminal stenting of tracheal collapse syndrome in dogs. J Vet Intern Med 2019; 33:2209-2216. [PMID: 31290188 PMCID: PMC6766514 DOI: 10.1111/jvim.15555] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 06/25/2019] [Indexed: 11/30/2022] Open
Abstract
Background Endoluminal tracheal stenting can relieve signs associated with tracheal collapse syndrome (TCS) in dogs, but major complications can result. Objective To identify associations among tracheal dimensions, stent dimensions, and subsequent complications requiring additional stent placement after endoluminal stenting for TCS. Animals Fifty‐two dogs from the hospital population. Methods Medical records of dogs that received an endoluminal self‐expanding tracheal stent for TCS by the interventional radiology service between 2009 and 2014 were reviewed for relevant data. Signalment and clinical details, including tracheal collapse type, tracheal measurements, nominal stent dimensions, follow‐up evaluation times, and stent complications, were recorded. Results Fifty‐two dogs that received an endoluminal stent for TCS met the inclusion criteria. Major complications included stent fracture (13/52; 25%), obstructive tissue ingrowth (10/52; 19%), and progressive tracheal collapse (6/52; 12%). Natural tracheal taper (P = .04) and more stent diameter oversizing (P = .04) in the intrathoracic (IT) trachea were associated with caudodorsal stent fracture. Only stents with a 14‐mm nominal diameter fractured. Progressive tracheal collapse was associated with smaller maximum tracheal diameters (P = .02). The majority of dogs with obstructive tissue ingrowth (7/10; 70%; P = .30) and all dogs with thoracic inlet fractures (3/3; 100%) had tracheal malformations. Conclusions and Clinical Importance A higher taper in tracheal diameter may lead to increased risk of fracture in the IT location. Dogs with tracheal malformations may have higher risk for thoracic inlet fracture and development of obstructive tissue ingrowth. Clinicians should be aware of the possible risk factors for tracheal stent complications.
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Affiliation(s)
- Nathaniel P Violette
- Department of Diagnostic Imaging and Interventional Radiology, The Animal Medical Center, New York, New York
| | - Chick Weisse
- Department of Diagnostic Imaging and Interventional Radiology, The Animal Medical Center, New York, New York
| | - Allyson C Berent
- Department of Diagnostic Imaging and Interventional Radiology, The Animal Medical Center, New York, New York
| | - Kenneth E Lamb
- Lamb Statistical Consulting LLC, West St. Paul, Minnesota
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Weisse C, Berent A, Violette N, McDougall R, Lamb K. Short-, intermediate-, and long-term results for endoluminal stent placement in dogs with tracheal collapse. J Am Vet Med Assoc 2019; 254:380-392. [DOI: 10.2460/javma.254.3.380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Clarke DL. Interventional Radiology Management of Tracheal and Bronchial Collapse. Vet Clin North Am Small Anim Pract 2018; 48:765-779. [DOI: 10.1016/j.cvsm.2018.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Raske M, Weisse C, Berent AC, McDougall R, Lamb K. Immediate, short-, and long-term changes in tracheal stent diameter, length, and positioning after placement in dogs with tracheal collapse syndrome. J Vet Intern Med 2018; 32:782-791. [PMID: 29460368 PMCID: PMC5867008 DOI: 10.1111/jvim.15063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 10/10/2017] [Accepted: 01/16/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Intraluminal tracheal stenting is a minimally invasive procedure shown to have variable degrees of success in managing clinical signs associated with tracheal collapse syndrome (CTCS) in dogs. OBJECTIVES Identify immediate post-stent changes in tracheal diameter, determine the extent of stent migration, and stent shortening after stent placement in the immediate-, short-, and long-term periods, and evaluate inter-observer reliability of radiographic measurements. ANIMALS Fifty client-owned dogs. METHODS Retrospective study in which medical records were reviewed in dogs with CTCS treated with an intraluminal tracheal stent. Data collected included signalment, location, and type of collapse, stent diameter and length, and post-stent placement radiographic follow-up times. Radiographs were used to obtain pre-stent tracheal measurements and post-stent placement measurements. RESULTS Immediate mean percentage change was 5.14%, 5.49%, and 21.64% for cervical, thoracic inlet, and intra-thoracic tracheal diameters, respectively. Ultimate mean follow-up time was 446 days, with mean percentage change of 2.55%, 15.09%, and 8.65% for cervical, thoracic inlet, and intra-thoracic tracheal diameters, respectively. Initial mean stent length was 26.72% higher than nominal length and ultimate long-term tracheal mean stent shortening was only 9.90%. No significant stent migration was identified in the immediate, short-, or long-term periods. Good inter-observer agreement of radiographic measurements was found among observers of variable experience level. CONCLUSIONS AND CLINICAL IMPORTANCE Use of an intraluminal tracheal stent for CTCS is associated with minimal stent shortening with no clinically relevant stent migration after fluoroscopic placement. Precise stent sizing and placement techniques likely play important roles in avoiding these reported complications.
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Affiliation(s)
| | | | | | | | - Kenneth Lamb
- Lamb Statistical Consulting LLC, West St. Paul, Minnesota
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Rosenheck S, Davis G, Sammarco CD, Bastian R. Effect of Variations in Stent Placement on Outcome of Endoluminal Stenting for Canine Tracheal Collapse. J Am Anim Hosp Assoc 2017; 53:150-158. [PMID: 28291400 DOI: 10.5326/jaaha-ms-6485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The study's objective was to determine effects of relative size and placement location of endoluminal stents on incidence of complications and survival for canine tracheal collapse. Measurements were obtained on lateral radiographs before and after stenting to determine percent of the trachea occupied by the stent. These values were monitored over time and compared to complication rates and survival. Overall median survival time was 502 days. Six month survival rate was 78%, 1 yr survival was 60%, and 2 yr survival was 26%. Median percent of trachea occupied by the stent at initial placement was 79% (range, 41-93%). Percent of the trachea occupied by the stent at the time of placement did not significantly correlate to complication rate (0.397) or survival time (0.853). Incidence of serious complications was 37%, including granuloma formation, pneumonia, material failure, and stent migration. For patients experiencing serious complications, median survival was shorter, at 208 days, but was not significantly different from survival without serious complications. Within the margins of the data from this study, the proportion of the trachea occupied by the stent at the time of placement does not appear to impact incidence of complications or survival time in dogs with tracheal collapse.
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Affiliation(s)
- Stephanie Rosenheck
- From the Department of Surgery, Center For Animal Referral and Emergency Services, Langhorne, Pennsylvania (S.R.); Red Bank Veterinary Hospital, Tinton Falls, New Jersey (S.R., G.D., C.D.S.); and Monmouth University, West Long Branch, New Jersey (R.B.)
| | - Garrett Davis
- From the Department of Surgery, Center For Animal Referral and Emergency Services, Langhorne, Pennsylvania (S.R.); Red Bank Veterinary Hospital, Tinton Falls, New Jersey (S.R., G.D., C.D.S.); and Monmouth University, West Long Branch, New Jersey (R.B.)
| | - Carl D Sammarco
- From the Department of Surgery, Center For Animal Referral and Emergency Services, Langhorne, Pennsylvania (S.R.); Red Bank Veterinary Hospital, Tinton Falls, New Jersey (S.R., G.D., C.D.S.); and Monmouth University, West Long Branch, New Jersey (R.B.)
| | - Richard Bastian
- From the Department of Surgery, Center For Animal Referral and Emergency Services, Langhorne, Pennsylvania (S.R.); Red Bank Veterinary Hospital, Tinton Falls, New Jersey (S.R., G.D., C.D.S.); and Monmouth University, West Long Branch, New Jersey (R.B.)
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Preston AR, Sullivan LA. Dislodgement of a right atrial thrombus and subsequent pulmonary thromboembolism following tracheal stent deployment in a dog. J Vet Emerg Crit Care (San Antonio) 2016; 26:809-814. [PMID: 27074582 DOI: 10.1111/vec.12459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/11/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the management of a dog that required 2 treatments with mechanical ventilation; firstly for severe tracheal collapse and secondly following deployment of a nitinol tracheal stent that immediately preceded a nonoxygen responsive pulmonary thromboembolism (PTE), suspected to have originated from the right atrium. CASE SUMMARY A 9-year-old female spayed Shetland Sheepdog was presented for management of a gallbladder mucocoele. Pertinent history included iatrogenic hyperadrenocorticism and tracheal collapse. The dog became clinical for tracheal collapse following laparoscopic cholecystectomy. Thoracic radiographs revealed moderate to severe tracheal collapse at the level of the thoracic inlet. Arterial blood gas was consistent with hypoventilation and mechanical ventilation was instituted. Given the severity of tracheal collapse, self-expanding nitinol tracheal stent placement was elected. Immediately following tracheal stent placement, the dog developed nonoxygen responsive hypoxemia requiring mechanical ventilation. Additional diagnostic tests revealed changes consistent with a PTE and a large thrombus in the right atrium. The dog was humanely euthanized. NEW OR UNIQUE INFORMATION PROVIDED Dislodgement of a preexisting atrial thrombus has not been described as a complication following tracheal stent deployment. Additionally, although PTE is frequently considered to be oxygen responsive, it may not be if the embolism is severe enough.
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Affiliation(s)
- Ayla R Preston
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Lauren A Sullivan
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO.
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Williams JM, Krebs IA, Riedesel EA, Zhao Q. COMPARISON OF FLUOROSCOPY AND COMPUTED TOMOGRAPHY FOR TRACHEAL LUMEN DIAMETER MEASUREMENT AND DETERMINATION OF INTRALUMINAL STENT SIZE IN HEALTHY DOGS. Vet Radiol Ultrasound 2016; 57:269-75. [PMID: 26784924 DOI: 10.1111/vru.12344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022] Open
Abstract
Tracheal collapse is a progressive airway disease that can ultimately result in complete airway obstruction. Intraluminal tracheal stents are a minimally invasive and viable treatment for tracheal collapse once the disease becomes refractory to medical management. Intraluminal stent size is chosen based on the maximum measured tracheal diameter during maximum inflation. The purpose of this prospective, cross-sectional study was to compare tracheal lumen diameter measurements and subsequent selected stent size using both fluoroscopy and CT and to evaluate inter- and intraobserver variability of the measurements. Seventeen healthy Beagles were anesthetized and imaged with fluoroscopy and CT with positive pressure ventilation to 20 cm H2 O. Fluoroscopic and CT maximum tracheal diameters were measured by three readers. Three individual measurements were made at eight predetermined tracheal sites for dorsoventral (height) and laterolateral (width) dimensions. Tracheal diameters and stent sizes (based on the maximum tracheal diameter + 10%) were analyzed using a linear mixed model. CT tracheal lumen diameters were larger compared to fluoroscopy at all locations (P-value < 0.0001). When comparing modalities, fluoroscopic and CT stent sizes were statistically different. Greater overall variation in tracheal diameter measurement (height or width) existed for fluoroscopy compared to CT, both within and among observers. The greater tracheal diameter measured with CT and lower measurement variability has clinical significance, as this may be the imaging modality of choice for appropriate stent selection to minimize complications in veterinary patients.
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Affiliation(s)
- Jackie M Williams
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50010
| | - Ingar A Krebs
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50010
| | - Elizabeth A Riedesel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50010
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, 53792
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15
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Tappin SW. Canine tracheal collapse. J Small Anim Pract 2016; 57:9-17. [DOI: 10.1111/jsap.12436] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/12/2015] [Accepted: 09/15/2015] [Indexed: 11/29/2022]
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16
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Beal MW. Tracheal stent placement for the emergency management of tracheal collapse in dogs. Top Companion Anim Med 2015; 28:106-11. [PMID: 24182999 DOI: 10.1053/j.tcam.2013.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dogs with tracheal collapse may present with life-threatening upper airway obstruction. In most instances, a conservative approach to treatment including oxygen support coupled with sedation and cooling measures will relieve respiratory effort and thus relieve airway obstruction. Dogs that fail this conservative approach require endotracheal intubation to ensure a patent airway. This population of patients would benefit from a more definitive, yet palliative treatment option to acutely relieve upper airway obstruction. Placement of a self-expanding metallic stent that spans the affected portion of the trachea will acutely provide the patient with a sustained patent airway and optimize the likelihood of a positive outcome.
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Affiliation(s)
- Matthew W Beal
- Emergency and Critical Care Medicine Service and Interventional Radiology Services, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA.
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17
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Granone TD. Anesthesia case of the month. Iatrogenic pneumothorax. J Am Vet Med Assoc 2015; 246:189-92. [PMID: 25554932 DOI: 10.2460/javma.246.2.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Tiffany D Granone
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610
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18
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Montgomery JE, Mathews KG, Marcellin-Little DJ, Hendrick S, Brown JC. Comparison of Radiography and Computed Tomography for Determining Tracheal Diameter and Length in Dogs. Vet Surg 2014; 44:114-8. [DOI: 10.1111/j.1532-950x.2014.12227.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 05/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- James E. Montgomery
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - Kyle G. Mathews
- College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
| | | | - Steve Hendrick
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - James C. Brown
- College of Veterinary Medicine; North Carolina State University; Raleigh North Carolina
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19
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Chisnell HK, Pardo AD. Long-term outcome, complications and disease progression in 23 dogs after placement of tracheal ring prostheses for treatment of extrathoracic tracheal collapse. Vet Surg 2014; 44:103-13. [PMID: 24909184 DOI: 10.1111/j.1532-950x.2014.12206.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report complications, long-term outcome, and disease progression in dogs with extrathoracic tracheal collapse treated by surgical placement of commercially available extraluminal rings. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 23). METHODS Medical records (2002-2011) of dogs treated with extraluminal rings for extrathoracic tracheal collapse were reviewed. Owner interviews, conducted at >10 months postoperatively, determined response to surgery, progression of clinical signs after surgery, and frequency of medication administration. Long-term re-evaluation (>10 months after surgery) was offered for surviving dogs, including radiographs and tracheoscopy if indicated. RESULTS Of 23 dogs, 22 survived to discharge after surgery. Clinical signs improved in all dogs at 2 weeks after surgery and at long-term re-evaluation. Fourteen dogs (65%) required no medical management for respiratory signs after surgery. Four dogs (17%) were diagnosed with laryngeal paralysis at some point after surgery, but only 9% were diagnosed within 48 hours of the surgery. Additional rings were placed between previously placed rings in 2 dogs, and 1 dog was treated with an endoluminal stent for intrathoracic tracheal collapse. Three dogs had clinical signs consistent with progression of tracheal collapse. Based on owner questionnaire, all owners were satisfied with surgical outcome. CONCLUSIONS Treatment of severe cervical tracheal collapse with commercially-available extraluminal ring placement leads to an overall improvement in quality of life and good long-term results, with about one-third of dogs requiring continued medical management. Most dogs do not have clinical signs consistent with disease progression after surgery.
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Affiliation(s)
- Hope K Chisnell
- Pittsburgh Veterinary Specialty and Emergency Center (PVSEC), Pittsburgh, Pennsylvania
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20
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Dengate A, Culvenor JA, Graham K, Braddock JA, Churcher RK. Bronchial stent placement in a dog with bronchomalacia and left atrial enlargement. J Small Anim Pract 2014; 55:225-8. [DOI: 10.1111/jsap.12183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Dengate
- North Shore Veterinary Specialist Centre; Crows Nest NSW 2065 Australia
| | - J. A. Culvenor
- North Shore Veterinary Specialist Centre; Crows Nest NSW 2065 Australia
| | - K. Graham
- North Shore Veterinary Specialist Centre; Crows Nest NSW 2065 Australia
| | - J. A. Braddock
- North Shore Veterinary Specialist Centre; Crows Nest NSW 2065 Australia
| | - R. K. Churcher
- North Shore Veterinary Specialist Centre; Crows Nest NSW 2065 Australia
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21
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Durant AM, Sura P, Rohrbach B, Bohling MW. Use of nitinol stents for end-stage tracheal collapse in dogs. Vet Surg 2012; 41:807-17. [PMID: 22957667 DOI: 10.1111/j.1532-950x.2012.01037.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report bronchoscopic placement of nitinol stents (Vet Stent-Trachea®) for improvement of end-stage clinical signs in dogs with tracheal collapse. STUDY DESIGN Case series. SAMPLE POPULATION Dogs (n = 18). METHODS Medical records (January 1, 2004-October 31, 2008) were searched for dogs with a diagnosis of tracheal collapse; 18 dogs met inclusion criteria. Tracheal diameter was compared before and after stent deployment. Stent dimensions were compared after stent deployment and at radiographic follow-up. RESULTS There was a significant difference in the minimum tracheal diameter when initial and post deployment tracheal diameters were compared (P = .003). Stent length was significantly shorter at follow-up when compared to post deployment measurements (P = .004). Owner assessment of outcome was available for all dogs with 11.1% mortality within 60 days. Complications were documented in 9 dogs. CONCLUSIONS Use of a nitinol stent (Vet Stent-Trachea®) in dogs with end-stage tracheal collapse is associated with a fair to good outcome despite significant temporal stent fore shortening after bronchoscopic placement.
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Affiliation(s)
- April M Durant
- Department of Small Animal Clinical Sciences, University of Tennessee, Knoxville, TN 37996, USA.
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22
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Kim DH, Choi CB, Chung WH, Lee SH, Lee AJ, Jeong JS, Kim HJ, Kim HY. Preliminary study for a newly designed silicone stent and delivery system for canine obstructive tracheal disease. J Vet Med Sci 2012; 74:1323-6. [PMID: 22673748 DOI: 10.1292/jvms.11-0448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The goal of this study was to prove the possibility of using silicone stents broadly used for human medicine in canine obstructive tracheal disease. A silicone stent anatomically designed for canine trachea was tested on 5 beagle dogs for 8 weeks. The stent was carefully inserted using a newly developed delivery device under fluoroscopic guidance. There were no technical difficulties in placing the stent during the procedure. Previously reported complications of airway stenting such as stent migration or granulation tissue formation did not occur in any of the cases. In addition, removal of the stent was as simple as inserting it, and complications were absent. The stent introduced in this study could possibly be applied to various canine obstructive tracheal diseases.
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Affiliation(s)
- Dae-Hyun Kim
- Department of Veterinary Surgery, Collage of Veterinary Medicine, Konkuk University, 1 Hwayang-dong, Gwangjin-gu, Seoul, Korea
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23
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Graham SB, Schilpp D, Bradley WM, Cook G, Gayle J. Treatment of traumatic tracheal collapse with extraluminal titanium mesh screens. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00126.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Brown SA, Williams JE, Saylor DK. Endotracheal stent granulation stenosis resolution after colchicine therapy in a dog. J Vet Intern Med 2008; 22:1052-5. [PMID: 18647163 DOI: 10.1111/j.1939-1676.2008.0135.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- S A Brown
- Internal Medicine and Critical Care Department, VCA Veterinary Referral Associates, North Potomac, MD 20878, USA.
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25
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Ouellet M, Dunn ME, Lussier B, Chailleux N, Hélie P. Noninvasive correction of a fractured endoluminal nitinol tracheal stent in a dog. J Am Anim Hosp Assoc 2008; 42:467-71. [PMID: 17088395 DOI: 10.5326/0420467] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 11-year-old, castrated male Pomeranian was presented for intractable cough and dyspnea secondary to severe tracheal collapse. An endoluminal nitinol tracheal stent was placed with good results. Five months following placement of the prosthesis, clinical signs acutely recurred and failure of the implant was noted. A second stent was superimposed over the fractured stent and resulted in resolution of all clinical signs. The dog died several months later from progression of the tracheal collapse to the carina and mainstem bronchi.
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Affiliation(s)
- Mathieu Ouellet
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, St-Hyacinthe, Quebec, J2S 7C6 Canada
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26
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Kim JY, Han HJ, Yun HY, Lee B, Jang HY, Eom KD, Park HM, Jeong SW. The safety and efficacy of a new self-expandable intratracheal nitinol stent for the tracheal collapse in dogs. J Vet Sci 2008; 9:91-3. [PMID: 18296893 PMCID: PMC2839118 DOI: 10.4142/jvs.2008.9.1.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To evaluate the potential utility of a self-expandable intratracheal nitinol stent with flared ends for the treatment of tracheal collapse in dogs, endotracheal stenting therapy was performed under fluoroscopic guidance in four dogs with severe tracheal collapse. During the 4 to 7 month follow-up, after stent implantation, clinical signs, including dyspnea and respiratory distress, dramatically improved in all dogs. The radiographs showed that the implanted stents improved the tracheal collapse, and there were no side effects such as collapse, shortening or migration of the stents. In conclusion, the self-expandable intratracheal nitinol stents provided adequate stability to the trachea and were effective for attenuating the clinical signs associated with severe tracheal collapse.
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Affiliation(s)
- Joon-young Kim
- College of Veterinary Medicine, Konkuk University, Seoul 143-701, Korea
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27
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Sun F, Usón J, Ezquerra J, Crisóstomo V, Luis L, Maynar M. Endotracheal stenting therapy in dogs with tracheal collapse. Vet J 2008; 175:186-93. [PMID: 17368061 DOI: 10.1016/j.tvjl.2007.01.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 10/03/2006] [Accepted: 01/27/2007] [Indexed: 11/19/2022]
Abstract
Tracheal collapse in dogs is a common respiratory disorder, typically presenting with a history of chronic cough, increasing respiratory difficulties, and episodes of dyspnoea. Medical treatment is the therapy of choice and surgical repair is considered when patients do not respond well. Minimally invasive endotracheal stenting is a promising new therapy under investigation, but there remain significant challenges to overcome potential complications. The purpose of this article is to provide a comparative overview of intra-luminal stenting of the trachea in human and veterinary medicine. The currently available stents and their potential clinical application to the veterinary patient will be discussed.
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Affiliation(s)
- Fei Sun
- Minimally Invasive Surgery Centre, Cáceres 10071, Spain.
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28
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Sura PA, Krahwinkel DJ. Self-expanding nitinol stents for the treatment of tracheal collapse in dogs: 12 cases (2001–2004). J Am Vet Med Assoc 2008; 232:228-36. [DOI: 10.2460/javma.232.2.228] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Culp WTN, Weisse C, Cole SG, Solomon JA. Intraluminal Tracheal Stenting for Treatment of Tracheal Narrowing in Three Cats. Vet Surg 2007; 36:107-13. [PMID: 17335417 DOI: 10.1111/j.1532-950x.2006.00225.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of intraluminal tracheal stenting in 3 cats with either benign or malignant tracheal obstruction. STUDY DESIGN Retrospective clinical study. ANIMALS Three client-owned cats. METHODS Medical records were reviewed and information regarding signalment, clinical signs, physical examination findings, diagnostic tests performed, treatment, outcome and follow-up were retrieved. Intraluminal tracheal stent placement was performed as previously described in the literature. RESULTS Three cats received intraluminal tracheal stents for the treatment of tracheal obstruction due to 3 different underlying causes: stricture secondary to traumatic endotracheal intubation, stricture secondary to a previous tracheotomy, and neoplasia. Self-expanding metallic stents of varying sizes were placed, and all cats recovered uneventfully from the procedures. The cat with tracheal neoplasia was euthanized because of pulmonary metastatic disease 6 weeks post-stent placement. The two cats with tracheal obstructions secondary to benign strictures are currently 39 months and 32 weeks post-stent placement, respectively. No complications were noted during the post-stent period in any of the 3 cats. CONCLUSIONS Intraluminal tracheal stenting was easily, safely, and rapidly performed without complications and resulted in immediate improvement in clinical signs in all three cases. None of the cats in this study developed significant stent-associated complications during the study period. CLINICAL RELEVANCE Intraluminal tracheal stenting has the potential to be a viable option for the treatment of tracheal obstruction in cats and perhaps for similar disease processes in other veterinary patients.
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Affiliation(s)
- William T N Culp
- Department of Clinical Studies, School of Veterinary Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-6010, USA.
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