Intra- and inter-observer reliability of combined segmental measurement techniques for predicting immediate post-deployment intraluminal tracheal stent length in dogs

This study evaluated segmental measurement techniques for predicting immediate post-deployment intraluminal tracheal stent length in dogs with naturally occurring tracheal collapse. Radiographs of 12 client-owned dogs that underwent intraluminal tracheal stent placement were retrospectively reviewed. Tracheal lengths were divided into 1, 2, 3, or 4 equal segments. Stent lengths were predicted using the widest dorsoventral height of each segment, with and without the addition of 10%, and an accompanying foreshortening chart. Techniques were compared for intra- and inter-observer reliability, and post-deployment stent length predictability. There was good to high intra- and inter-observer reliability for all segmental measurements; median intra-class correlation coefficients were 0.98 and 0.92, respectively. Measuring 2 segments without the addition of 10% to the widths was significantly more accurate in predicting immediate post-deployment stent length in terms of percent (P = 0.03) and absolute difference (P = 0.02). Segmental measuring techniques are repeatable amongst observers and may help guide stent selection.     

Management of advanced tracheal collapse in dogs using intraluminal self-expanding biliary wallstents

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.     

Use of intraluminal nitinol stents in the treatment of tracheal collapse in a dog

Tracheal collapse is a common problem that is typically observed in middle-aged and older small-breed dogs. It is a structural, obstructive airway disease with a dynamic component that can affect the intra- and extrathoracic portions of the trachea and mainstem bronchi. Many methods of treatment have been suggested, including medical management and provision of extraluminal and intraluminal support. All techniques used to treat intrathoracic and mainstem bronchial collapse have been associated with major complications or limitations. This report describes the implantation of intraluminal nitinol stents to successfully treat intrathoracic as well as extrathoracic tracheal collapse in a dog. The stents are composed of material that has characteristics similar to those of the trachea; nitinol stents may provide a method of supporting intrathoracic tracheal and mainstem bronchial collapse in dogs.     

Self-expanding nitinol stents for the treatment of tracheal collapse in dogs: 12 cases (2001-2004)

OBJECTIVE: To evaluate long-term outcome following nitinol stent placement in dogs with tracheal collapse. DESIGN: Retrospective case series. ANIMALS: 12 client-owned dogs with endoscopically diagnosed tracheal collapse refractory to medical management. PROCEDURES: Medical records were reviewed for 12 dogs in which 1 or more self-expanding nitinol stents were placed for the treatment of endoscopically diagnosed tracheal collapse. A total of 17 stents were placed. RESULTS: Survival times after stent placement ranged from 1 to 48 months. Three of 12 dogs died within 6 months after stent placement. Nine dogs survived > 1 year after stent placement, and 7 dogs survived > 2 years. Of the deceased dogs, 5 of 9 succumbed to tracheal disease. Other causes of death included congestive heart failure, cerebral neoplasia, cerebrovascular accident, and renal failure. Material failure (stent fracture) was a common complication (5/12 dogs). Other complications reported included excessive granulation tissue within the stent lumen, tracheitis, and pneumonia. CONCLUSIONS AND CLINICAL RELEVANCE: Placement of an intraluminal stent with self-expanding nitinol stents was a successful palliative treatment for tracheal collapse in dogs that did not respond to medical management. Disease progression is inevitable, but substantial improvement in respiratory function may be achieved for a period of months to years.     

A Comparison of Simple Continuous Versus Simple Interrupted Suture Patterns for Tracheal Anastomosis After Large-Segment Tracheal Resection in Dogs

Two suture techniques for tracheal anastomosis after large-segment tracheal resection were compared. Eight cartilages were resected from the trachea of each of 12 dogs; anastomoses with 4-0 polydioxanone suture were created using a simple continuous suture technique in six dogs and a simple interrupted suture technique in six dogs. Surgical time was shorter but apposition of tracheal segments at the time of surgery was less precise with the simple continuous suture technique. The dogs were evaluated for 150 days after surgery. Clinical abnormalities after tracheal resection and anastomosis were not observed. Percent dorsoventral luminal stenosis was calculated by measuring the tracheal lumen diameter on lateral cervical radiographs. Percent luminal stenosis was calculated planimetrically using a computerized digitizing tablet. Anastomotic stenosis was mild in all dogs; however, the mean percent luminal stenosis determined planimetrically was significantly greater for dogs that had the simple continuous suture technique. Planimetric measurements of cross-sectional area made before and after formalin fixation were not significantly different. Radiographic determination of percent dorsoventral luminal stenosis was a poor predictor of diminution of cross-sectional area determined planimetrically.     

Placement of intraluminal stents for treating tracheal collapse in dogs

Tracheal collapse is a progressive disease particularly of small breed dogs. In the terminal stage, when dyspnea becomes the dominating sign and is no longer manageable with medical treatment, a surgical procedure is necessary. With increasing frequency intraluminal tracheal stents are implanted minimal-invasively. In individual animals this is a lifesaving procedure, leading to immediate elimination of dyspnea. In most dogs cough for some time has to be anticipated as the stent acts as a foreign body, but severe complications like excessive formation of granulation tissue, stent migration or stent fracture are rare. Stents represent an attractive treatment modality for tracheal collapse in dogs with dyspnea.     

A RETROSPECTIVE STUDY OF THE RELATIONSHIP BETWEEN TRACHEAL COLLAPSE AND BRONCHIECTASIS IN DOGS

Tracheal collapse is common in middle age toy and miniature breed dogs. Cartilaginous defects have been identified histologically and are considered a form of chondromalacia. In addition to tracheal cartilaginous changes, concurrent lower airway histologic changes indicative of inflammation have been noted in dogs with tracheal collapse and these changes may lead t o concurrent bronchiectasis. The purpose of this study was to investigate the prevalence of bronchiectasis in dogs with a previous radiographic diagnosis of tracheal collapse. The thoracic radiographs of 60 dogs with tracheal collapse were evaluated for evidence of concurrent bronchiectasis. Eighteen of 60 (30%) dogs had evidence of bronchiectasis, and all were cylindrical in morphology. The signalment of affected dogs was similar to that previously reported. The occurrence of bronchiectasis in this group of dogs with tracheal collapse (18 dogs) was six times higher (P < 0.05) than the expected prevalence within a random sample population (three dogs). The results of this study provide evidence of a link between tracheal collapse and bronchiectasis. A finding of bronchiectasis with tracheal collapse should encourage further evaluation for chronic lower airway disease in these patients.     

Fluoroscopic and radiographic evaluation of tracheal collapse in dogs: 62 cases (2001-2006)

OBJECTIVE: To compare the use of radiography and fluoroscopy for detection and grading of tracheal collapse in dogs. DESIGN: Retrospective case series. Animals-62 dogs with tracheal collapse. PROCEDURES: For each dog, tracheal collapse was confirmed fluoroscopically and lateral cervical and thoracic radiographic views were reviewed. A board-certified radiologist (who was unaware of the dogs' clinical history) evaluated the cervical, thoracic inlet, thoracic, carinal, and main stem bronchial regions in all fluoroscopic videos and radiographic images for evidence of collapse. Cervical, thoracic inlet, thoracic, and carinal regions in both radio-graphic and fluoroscopic studies were graded for collapse (0%, 25%, 50%, 75%, or 100% decrease in diameter). RESULTS: Lateral cervical and thoracic radiographic images were available for 54 dogs, and inspiratory and expiratory lateral cervical and thoracic radiographic images were available for 8 dogs. For detection of tracheal collapse, assessment of radiographic views was sensitive and had the best negative predictive value in the cervical and thoracic inlet regions. Assessment of radiographic views was most specific and had the best positive predictive value in the thoracic inlet, thoracic, carina, and main stem bronchial regions. Radiography underestimated the degree of collapse in all areas. Review of inspiratory and expiratory views improved the accuracy of radiography for tracheal collapse diagnosis only slightly. CONCLUSIONS AND CLINICAL RELEVANCE: Compared with fluoroscopy, radiography underestimated the frequency and degree of tracheal collapse. However, radiography appears to be useful for screening dogs with potential tracheal collapse.     

The Safety and efficacy of a new self-expandable intratracheal nitinol stent for the tracheal collapse in dogs

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.     

COMPARISON OF THE RADIOGRAPHIC AND TRACHEOSCOPIC APPEARANCE OF THE DORSAL TRACHEAL MEMBRANE IN LARGE AND SMALL BREED DOGS

The etiology and clinical significance of increased radiographic opacity along the dorsal margin of the tracheal lumen has long been debated. Most often, this opacity is attributed to redundancy of the dorsal tracheal membrane (DTM), a condition that occurs with tracheal collapse. We hypothesized that the underlying etiology of this radiographic opacity differs between small breed dogs with tracheal collapse and small or large breed dogs without tracheal collapse. The purpose of this prospective, cross‐sectional study was to compare the radiographic appearance of an increased opacity within the trachea to tracheoscopy findings in a group of small and large breed dogs. A total of 17 small breed dogs and 16 large breed dogs were included. Of these, only one did not have a radiographically visible DTM. Small breed dogs were divided into groups with tracheal collapse (n = 8) and those without (n = 9) based on tracheoscopy. Tracheal collapse was absent in larger breed dogs, however both large and small breed dogs demonstrated inward invagination of the DTM. In dogs with tracheal collapse, the DTM occupied a larger percentage of the tracheal luminal height on radiographs and a larger percentage of tracheal circumference on tracheoscopy vs. dogs with an invaginated DTM on tracheoscopy and dogs with no collapse and no invagination of the DTM. Findings supported the hypothesis that increased radiographic opacity along the dorsal margin of the trachea arises from different etiologies in dogs with and without tracheal collapse.     

The use of intraluminal stents for tracheal collapse in two horses: Case management and long‐term treatment

Tracheal collapse is an uncommon clinical disorder in horses but when present can be difficult to correct. Various medical and surgical procedures to correct tracheal collapse have been described in horses with variable success. Recently, the use of an intraluminal stent has been described as a treatment for tracheal collapse in a miniature horse. The long‐term management, utilising intraluminal stents, in 2 miniature horses with tracheal collapse is presented here. In particular, various complications as a result of intraluminal stent placement are described, the most persistent being the formation of granulation tissue at various regions of the stents. Multiple methods of combating granulation tissue in this situation also are discussed.     

Tracheal Anastomosis in the Dog Comparison of Two End-to-End Techniques

Two techniques for tracheal resection and anastomosis were performed and compared in 20 normal dogs. In one technique, cartilage rings were split circumferentially, and the split rings were apposed with simple interrupted sutures that penetrated the annular ligament. In the other technique, the annular ligaments were incised and apposed with simple interrupted sutures placed through the annular ligament and around the adjacent ring. Endoscopy and xeroradiography were used to evaluate the anastomotic sites at 1, 2, 4, and 8 weeks postoperatively. Infection, mucus accumulation, coughing, stridor, or anastomotic separations were not seen. Stenosis of the anastomotic site was observed in 80% of the dogs, due to the intraluminal protrusion of epithelialized fibrous connective tissue. The split cartilage technique was easy to perform and resulted in less dorsoventral stenosis than the annular ligament technique.     

Kinematics of the equine thoracolumbar spine

At least three types of movement take place in the joint complexes of the equine thoracolumbar spine: dorsoventral flexion and extension, axial rotation and lateral bending. Using the standard right-handed Cartesian coordinate system, these movements may be defined as rotation about the x, y and z axes respectively. Except in cases of intervertebral fusion, all three types of movement occur in each joint complex of the equine back. The greatest amount of dorsoventral movement takes place at the lumbosacral and the first thoracic intervertebral joints. The greatest amount of axial rotation and lateral bending was measured in the mid-thoracolumbar spine at the level of the 11th or 12th thoracic intervertebral joints. The caudal thoracic and the lumbar spine is the least mobile region of the equine back. In the mid-thoracic spine, lateral bending was always accompanied by a "coupled" axial rotation. The presence of the rib cage stabilised the cranial thoracic vertebrae against axial rotation.     

Use of ultrasonography in the diagnosis of tracheal collapse

Ultrasonographic Imaging of the cervical trachea was performed with the neck in both a neutral and a hyperextended position in 10 dogs with tracheal collapse. Tracheoscopy was used to confirm a diagnosis of tracheal collapse. The ultrasound investigation was repeated in 10 dogs of similar size but without tracheal abnormality. The ultrasonographic findings of the affected dogs were compared with those of the normal group and showed an alteration in the shape of the tracheal lumen in the ventrodorsal projection. This study highlights the possibility of identifying changes in the shape of the tracheal lumen during ultrasound investigations as an aid to the diagnosis of tracheal collapse.     

Sound signature for identification of tracheal collapse and laryngeal paralysis in dogs

The aims of this study were to investigate whether upper airway sounds of dogs with laryngeal paralysis and tracheal collapse have distinct sound characteristics, compared with unaffected dogs. The sounds of 5 dogs with laryngeal paralysis and 5 dogs with tracheal collapse were recorded. Honking sound appeared as predominant clinical signs in dogs with tracheal collapse. Laryngeal stridors appeared as predominant clinical signs in dogs with experimentally produced laryngeal paralysis by resection of laryngeal nerve, in which two types of stridor, I and II, were recorded. All these sounds were analyzed using sound spectrogam analysis. There were significant differences in duration (sec), intensity (dB), pitch (Hz), first formant (Hz), second formant (Hz), third formant (Hz), fourth formant (Hz) of sounds between the normal bark and two types of stridor or honking sound, indicating that the sound analysis might be a useful diagnostic modality for dogs with tracheal collapse and laryngeal paralysis.     

Liver disease in dogs with tracheal collapse

BACKGROUND: Hepatopathy in dogs with chronic respiratory diseases is poorly recognized. The aim of this study was to evaluate liver parameters alanine transferase, alkaline phosphatase, and glutamate dehydrogenase, as well as basal and stimulated bile acid concentration, in dogs with tracheal collapse. HYPOTHESIS: Dogs with tracheal collapse have hepatopathy. ANIMALS: 26 dogs with tracheal collapse. MATERIALS AND METHODS: Gall bladder contraction was stimulated by intramuscular injection of a synthetic cholecystokinin analogue (ceruletide). Twelve healthy Beagle dogs and 30 dogs of various breeds investigated previously without evidence of hepatic, gastrointestinal, or respiratory diseases served as control. Amelioration of liver variables was assessed after stent implantation. RESULTS: Twelve of 26 (46%) dogs had increased serum activity of 2 or more liver enzymes. Serum basal bile acid concentrations were high in 24 of 26 dogs. Twenty- and 40-minute stimulated bile acids were significantly higher in dogs with tracheal collapse (64.2 +130.0/-43.0 micromol/L and 82.6 +164.0/-57.1 micromol/L) compared to the control dogs (7.0 +/- 3.6 micromol/L and 6.4 +/- 3.5 micromol/L). All twelve dogs reevaluated after a median of 58 days (48-219 days) had a normal breathing pattern and significantly decreased 20 and 40 minutes stimulated bile acids (50.0 +92.7/-32.8 micromol/L, 52.8 +97.6/-34.3 micromol/L; P = .0043), whereas plasma liver enzyme activities were not significantly influenced. CONCLUSION AND CLINICAL IMPORTANCE: There was a significant hepatic dysfunction in the majority of dogs with a tracheal collapse. Liver function should be routinely assessed in dogs with severe respiratory disease.     

Laryngeal collapse in seven brachycephalic puppies

OBJECTIVES: To document the histories, clinical findings, and management of seven puppies with laryngeal collapse occurring secondarily to brachycephalic airway syndrome. METHODS: Seven brachycephalic puppies aged between 4.5 and six months underwent surgery for management of brachycephalic airway syndrome following presentation for exercise intolerance and increased respiratory noise and effort. RESULTS: Stenotic nares of varying severity and an elongated soft palate were common to all dogs. All dogs had tracheal hypoplasia and this was severe in four dogs. Laryngeal collapse was present in all dogs. Two dogs had stage I, four dogs stage II, and one dog stage III laryngeal collapse. The dog with stage III laryngeal collapse and one dog with stage II laryngeal collapse died. There was no apparent association between the changes evident on thoracic radiographs or the degree of tracheal hypoplasia and postoperative outcome. CLINICAL SIGNIFICANCE: The development of severe secondary laryngeal changes in dogs aged six months or less supports the suggestion that immature brachycephalic dogs should undergo assessment and, if indicated, surgery as soon as any clinical signs of BAS are apparent.     

Tracheal Collapse and Bronchomalacia in Dogs: 58 Cases (7/2001–1/2008)

Background: Tracheobronchomalacia is diagnosed in people by documentation of a reduction in airway diameter during bronchoscopy. While tracheal collapse in the dog has been well described in the literature, little information is available on bronchomalacia in the dog. Hypotheses: Bronchomalacia is common in dogs with tracheal collapse, is associated with inflammatory airway disease, and is poorly documented radiographically. Animals: One hundred and fifteen dogs admitted for evaluation for respiratory disease and examined by bronchoscopy. Methods: Case‐controlled, observational study. Dogs examined and having a bronchoscopic procedure performed by a single operator were separated into groups with and without visually identified airway collapse. Clinical parameters and bronchoalveolar lavage findings were compared between groups. Radiographs were reviewed in masked fashion to assess the sensitivity and specificity for detection of bronchomalacia. Results: Tracheobronchomalacia was documented in 50% of dogs examined, with tracheal collapse in 21% and bronchomalacia in 47%. In dogs with bronchomalacia, collapse of the right middle (59%) and left cranial (52%) lung lobes was identified most commonly. Dogs with bronchomalacia were significantly more likely to display normal airway cytology and to have mitral regurgitation and cardiomegaly than dogs without airway collapse (P < .05). Radiographs were insensitive for detection of airway collapse. Conclusions and Clinical Importance: Bronchomalacia was identified more commonly than tracheal collapse in this population of dogs, and documentation required bronchoscopy. This study could not confirm a role for airway inflammation in bronchomalacia, and further studies are required to determine the role of cardiomegaly in the disorder.     

Clinical and microbiologic findings in dogs with bronchoscopically diagnosed tracheal collapse: 37 cases (1990-1995).

OBJECTIVE: To investigate the role of bacteria in bronchoscopically diagnosed tracheal collapse in dogs by evaluating qualitative results of bacteriologic cultures. DESIGN: Retrospective study. ANIMALS: 37 dogs with tracheal collapse. PROCEDURE: Clinical records for dogs with tracheal collapse confirmed with bronchoscopy were reviewed. A protected catheter brush was used to obtain samples for bacteriologic culture from the large airways. RESULTS: Results of bacterial culture were negative for 5 of 29 dogs. For 24 dogs, 1 (n = 10), 2 (6), or > or = 3 (8) species of bacteria were isolated. Pseudomonas spp were isolated most frequently (17/29), and a single Pseudomonas sp grew in 7 samples. Other bacteria included Enterobacter spp (4/29), Citrobacter spp (3/29), and Moraxella spp, Klebsiella spp, Bordetella spp, or Acinetobacter spp (2/29 dogs each). Anaerobic and aerobic cultures yielded positive results in samples from 2 dogs. Cytologic results were available for 13 dogs with positive results of bacteriologic culture; epithelial cells were reported most commonly. Five samples had a small number of neutrophils; bacteria were identified cytologically in 2 of 5 samples that contained neutrophils. Bacteria were also seen in 2 samples that lacked inflammatory cells. CONCLUSIONS AND CLINICAL RELEVANCE: Bacteria are commonly isolated from samples obtained via airway brushing in dogs with tracheal collapse; however, in the absence of cytologic confirmation of inflammation or infection, an association between bacteria and clinical signs of tracheal collapse cannot be established.     

Tracheal collapse in two cats

Two cats examined bronchoscopically to discover the cause of tracheal collapse were found to have tracheal obstruction cranial to the collapse. Cats with this unusual sign should be examined bronchoscopically to ascertain whether there is an obstruction, as the cause in these 2 cats was distinct from the diffuse airway abnormality that causes tracheal collapse in dogs.