Tracheal collapse in the dog - is there really a role for surgery? A survey of 100 cases

One hundred dogs with clinical signs associated with tracheal collapse were examined over a four-year period. The symptomatic state of tracheal collapse was found to have a multifactorial aetiology. Factors linked with the onset of clinical signs included cardiomegaly, pulmonary oedema, respiratory infection, endotracheal intubation, the presence of a smoker in the household, allergic respiratory disease and obesity. Medical or conservative management resulted in long term resolution of signs (greater than 12 months) in 71 per cent of cases while a further 4 per cent were successfully managed by upper airway surgery. Tracheal reconstruction was performed for the minority of non-responsive cases (11 per cent) in which no other medical condition could be identified. Only half of these dogs (5 per cent) remained asymptomatic long term. The importance of identifying and eliminating the factors implicated in initiating the symptomatic state of tracheal collapse is emphasised. Suppression of these exciting causes should be considered as the therapeutic priority and surgery should be reserved only for those dogs which do not respond to conservative management.     

Atypical lateral tracheal collapse in a Yorkshire terrier

A 10-month-old, neutered female Yorkshire terrier was presented with a 6-month history of inspiratory dyspnoea, coughing and exercise intolerance. Tracheoscopy revealed marked lateral-to-lateral fixed collapse of the cervical trachea and mild collapse of the thoracic trachea. Surgical exploration revealed a marked reduction in lateral tracheal width and multiple malformed tracheal rings. Placement of extraluminal ring prostheses around the cervical trachea resulted in widening of the tracheal diameter and an immediate improvement in clinical signs. 6 years postoperatively the patient was reported to have an excellent quality of life with complete resolution of clinical signs.     

Extraluminal,C Shaped Polyethylene Prostheses in Two Ponies with Tracheal Collapse

Objective: To describe the surgical technique, complications, and outcome after use of extraluminal prostheses in 2 ponies with severe tracheal collapse. Study Design: Clinical report. Animals: Ponies (n=2) with severe tracheal collapse. Methods: A ventral median approach was used to expose the trachea from the larynx to the manubrium. Extraluminal, high‐density polyethylene, C‐shaped prostheses were sutured to the dorsal tracheal membrane and tracheal rings to provide external tracheal support. Results: The surgical approach provided good tracheal access and placement of the rings was uncomplicated. Initial estimates of the tracheal diameter from preoperative radiographs resulted in prostheses that were too small at surgery requiring a 2nd surgical procedure in 1 pony. Postoperative complications were coughing, right laryngeal hemiplegia, seroma formation, and antimicrobial induced colitis. Both ponies had marked resolution of clinical abnormalities after surgery. Recurrent esophageal obstruction resulted in euthanasia of 1 pony 3.5 years after surgery. The other pony was doing well 1 year after surgery. Conclusions: Extraluminal support of the trachea resulted in rapid resolution of clinical signs in 2 ponies with tracheal collapse. Clinical Relevance: Extraluminal tracheal prostheses can resolve clinical abnormalities in ponies with severe tracheal collapse.     

Surgical management of atypical lateral tracheal collapse in a dog

A FOUR-year-old spayed miniature poodle was presented for evaluation because of a chronic cough which had been present from eight weeks of age. The condition had gradually worsened until exercise intolerance, inappetence and abdominal breathing occurred. The dog was thin and weighed only 1.5 kg. Auscultation revealed tachycardia, a normal respiratory rate and wheezing noises - more prominent on inspiration and localised to the cervical portion of the trachea. There was marked inspiratory and expiratory effort. Tracheal sensitivity was moderate and palpation induced a dry hacking cough. Radiography demonstrated mild thickening of the bronchial wall and pulmonary hyperinflation. Expiratory/inspiratory radiographs failed to demonstrate dynamic tracheal collapse. On fluroscopy, substantial changes in tracheal calibre were not apparent. Bronchoscopy was performed and the tracheal lumen was normal up to 12.5 cm from the incisors. At this point, there was lateral tracheal collapse to about 30 per cent. There was dynamic collapse with respiratory effort. The bronchoscope could be passed beyond the narrowing (consisting of five tracheal rings) to a trachea of normal size. No pathogens were found on tracheal lavage. Surgery was undertaken through a midline, ventral approach. Six specially made tracheal ring prostheses were individually inserted around the trachea and inside the recurrent laryngeal nerve. Each prosthesis was sutured in four places to the tracheal ring, to give external support. The dog improved clinically and 11 months after surgery, bronchoscopy was again performed. The trachea was narrowed to approximately 60 per cent but there was no dynamic collapse of the airway. Twenty-seven months after surgery the dog continued to lead a healthy active life.     

Treatment of traumatic tracheal collapse with extraluminal titanium mesh screens

A 12‐year‐old Thoroughbred gelding presented with a history of exercise intolerance and inspiratory stridor. Physical examination revealed a blunt crush injury to the ventral neck and underlying trachea of unknown duration. Tracheoscopy revealed a grade 3 tracheal collapse. Surgical management of the case involved placement of extraluminal titanium mesh screens circumferentially around the trachea for complete support. During the period of hospitalisation, the only post operative complication was seroma formation, which resolved with routine care. Follow‐up after 5 years revealed no further evidence of exercise intolerance, inspiratory dyspnoea or stridor. The horse returned to his previous level of work as a show hunter.     

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.     

Results of surgical correction of abnormalities associated with brachycephalic airway obstruction syndrome in dogs in Australia

OBJECTIVES: To describe clinical features of brachycephalic airway obstructive disease in dogs, the incidence of laryngeal collapse in dogs presenting for surgery and the outcome after surgery in dogs with laryngeal collapse. METHODS: Basic clinical details were reviewed retrospectively in 73 dogs. Presence of laryngeal collapse and short-term outcomes after surgery were determined for 64 dogs with complete medical records. Long-term outcomes were reviewed for 46 dogs by telephone survey between 19 and 77 months following surgery. RESULTS: Stenotic nares were present in 31 dogs (42.5 per cent), elongated soft palate in 63 (86.3 per cent) and everted laryngeal saccules in 43 (58.9 per cent). The most common breeds were the pug (19 dogs, 26 per cent), Cavalier King Charles spaniel (15 dogs, 20.5 per cent), British bulldog (14 dogs, 19.2 per cent) and Staffordshire bull terrier (4 dogs, 5.5 per cent). Laryngeal collapse was present in 34 of 64 (53 per cent) dogs. No dogs died perioperatively and only one dog was euthanased as a result of its respiratory disease three years after surgery. Telephone interviews indicated that 26 dogs (56.5 per cent) were much improved after surgery, 15 (32.6 per cent) had some improvement and 5 (10.9 per cent) showed no improvement. Signs that persisted after surgery were snoring during sleep (34 dogs, 73.9 per cent), stertor/stridor while conscious (23 dogs, 50 per cent), excessive panting (13 dogs, 28.3 per cent) and dyspnoea (10 dogs, 21.7 per cent). Long-term outcome was considered good, even in dogs with laryngeal collapse. CLINICAL SIGNIFICANCE: Laryngeal collapse is relatively common in dogs presented for surgical correction of brachycephalic airway obstructive disease. Dogs with severe laryngeal collapse often respond well to surgery. Clinical signs rarely resolve completely following surgery.     

Tracheal surgery in dogs: a review

Though tracheal injuries often appear only superficial, exploration may reveal severe lacerations or fractures of the cartilaginous rings. A thorough physical examination and thoracic radiographs should precede tracheal surgery. Severe tracheal trauma is best repaired by partial resection and primary end-to-end anastomosis. Tension-relieving sutures aid healing of the anastomotic area, which is closed with synthetic absorbable sutures with extraluminal knots. Tracheal collapse, which primarily occurs in small or toy breeds, causes inspiratory dyspnea and can be corrected with polypropylene prostheses. Permanent tracheostomy may be required with laryngeal paralysis or irreparable tracheal injuries.     

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.     

Noninvasive correction of a fractured endoluminal nitinol tracheal stent in a dog

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.     

Fracture of an endoluminal nitinol stent used in the treatment of tracheal collapse in a dog

A 5-year-old castrated male Pomeranian was evaluated because of severe dyspnea and coughing, and a diagnosis of complete, static collapse of the trachea at the thoracic inlet was made. After failure to improve with medical management alone, an endoluminal tracheal stent was placed, which resulted in resolution of signs. Ten weeks after stent placement, the dog underwent tracheal resection and anastomosis because the stent had fractured at the level of the thoracic inlet. One year after surgery, the dog was doing well and required treatment with hydrocodone infrequently. Compared with other surgical treatment options, placement of an endoluminal tracheal stent is a relatively noninvasive intervention that can provide effective relief from the clinical signs associated with tracheal collapse in dogs. Implantation of endoluminal tracheal stents may be associated with complications; therefore, the procedure may best be regarded as a salvage procedure for dogs with end-stage disease that are refractory to appropriate medical management, have extensive collapse of the intrathoracic portion of the trachea, or are poor candidates for surgery.     

The Etiology and Surgical Management of Tracheal Collapse in Calves

The mean ages of 10 calves with tracheal collapse were 2.7 weeks at onset of clinical signs and 9.4 weeks at presentation for treatment. Inspiratory and expiratory dyspnea and stunted growth were the most common clinical signs. There were abnormalities of the cranial ribs consistent with healing fractures with redundant callus in eight lateral thoracic radiographs. Tracheal collapse in calves may result from cranial thoracic trauma during or soon after birth. Short polypropylene ring prostheses made from 60 ml syringe barrels were placed on the tracheas of four calves with cervical tracheal collapse. There were cranial rib masses in all calves and resection of the right first and second ribs was necessary in one calf to allow placement of prostheses. Dyspnea was relieved in all calves. One calf died of unrelated causes in year 3, and one calf had recurrence of clinical signs at month 5 and was euthanatized. In both calves, tracheal stenosis resulted from continued growth and infolding of the trachea within the constraints of the prostheses. One calf was alive at month 11, and one calf died of acute bronchopneumonia on day 2. Removal of tracheal prostheses in calves is recommended after 2 to 3 months if clinical signs recur.     

Unilateral arytenoid lateralisation: An assessment of technique and long term results in 62 dogs with laryngeal paralysis

Sixty-two dogs with laryngeal paralysis were presented over a three year period. Presenting clinical signs included inspiratory stridor (100 per cent), exercise intolerance or syncopal episodes (81 per cent), loss or alteration in phonation (48 per cent) and coughing or gagging when eating (29 per cent). Causes of the paralysis were determined as traumatic (two dogs), neoplastic (two dogs), iatrogenic (two dogs), congenital (one dog) and idiopathic (55 dogs). Unilateral arytenoid lateralisation was performed in all dogs. The perioperative complication rate was approximately 10 per cent, while the success rate as judged by owners one year postoperatively was greater than 90 per cent. The technique avoided many of the recorded complications of intralaryngeal surgery. Operative times were short and the requirement for postoperative monitoring was minimal. Increasing familiarity with the technique favourably influenced the incidence of complications and the success rate.     

Respiratory and cardiac arrest under general anaesthesia: treatment by acupuncture of the nasal philtrum

The philtrum point VG 26 (Jen Chung) was needled in 69 cases of respiratory depression or apnoea in dogs and cats during induction or maintenance of general anaesthesia. Respiration was restored to normal or near normal rates within 10 to 30 seconds of insertion of the needle in all the cases. In seven cases of anaesthetic apnoea with concurrent cardiac arrest and absence of vital signs, the revival rate was 43 per cent. Those which recovered required four to 10 minutes of acupuncture stimulation. In eight cases of collapse due to other causes, the revival rate was 25 per cent. The cases included five sheep in shock following liver biopsy, two cases of haemorrhagic shock (dog, cat) and one terminal collapse in chronic congestive heart failure (dog).     

Tracheal collapse in a four month old Uckermaerker heifer

This report describes a case of tracheal collapse in a four month old Uckermaerker heifer. The animal was born spontaneous without signs of dystocia. It was kept outside on the pasture and died in the summer at high temperatures under signs of acute dyspnea and respiratory failure. Clinical symptoms were not observed by the owner until a few hours before death. At necropsy, the middle and caudal third of the trachea was found to be collapsed due to an inward bending of the dorsal ends of the cartilage rings. The most severe luminal reduction was located in the thoracic part of the trachea approximately 5 cm cranial the tracheal bronchus. Additional pathological lesions were absent except for signs of circulatory failure (lung edema, congestion of the shock organs). Based on clinical history and pathological findings, a traumatic cause of the tracheal collapse is unlikely. However, a hereditary influence seems possible since analysis of the breeding scheme revealed inbreeding. The mother of the affected animal was mated with her grandson (inbreeding coefficient 0,125).     

Mechanical properties of the isolated equine trachea

In order to study the in vitro mechanical properties of the equine trachea submitted to the compressive pressures observed in vivo, the pressure-volume relationship was determined in intra- and extra-thoracic tracheal segments taken post mortem from 29 healthy horses (one to 15 years old; 352 to 651 kg). At the same time, the cross-sectional lumen area (X-SA) at the mid-point of the segment was measured using a slit-lamp transillumination and photographic measurement by endoscopy. The tracheal specific compliance (Cs) as well as the relative changes in X-SA and in the sagittal and transverse diameters, for intraluminal pressures from 5 to - 5 kPa, were calculated. The extrathoracic tracheal Cs was 0.060 +/- 0.002 kPa-1 and, at an intraluminal pressure of - 5 kPa, X-SA was reduced to about 73 per cent of its resting value. The intrathoracic segments were more compliant and, at similar compressive pressure, their X-SA was more reduced. These data show that the equine tracheal compliance is high and suggest that the increase in pulmonary resistance observed during strenuous exercise may be partly explained by a partial 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.     

Retrospective study of indications for and outcome of perineal urethrostomy in cats

OBJECTIVES: To evaluate indications for and outcome of perineal urethrostomy in cats. METHODS: The medical records of 59 cats that had undergone perineal urethrostomy were evaluated. Short-term follow up information (for a period of four weeks following surgery) was available for all of the cats. Long-term follow up information (for a period of at least four months) was available for 39 cats. RESULTS: Early complications occurred in 25.4 per cent of cats and late complications were observed in 28.2 per cent of cats. The most frequent late complication was recurring bacterial urinary tract Infection. CLINICAL SIGNIFICANCE: Despite frequent complications and recurring signs of lower urinary tract disease, 32.2 per cent of the cats had a disease-free long-term outcome (mean four years, median 3.9 years), and 88.6 per cent of clients interviewed thought that their cats had a good quality of life after surgery.     

Prevalence of clinical signs of disease in Danish finisher pigs

Between December 1999 and February 2001, two visits, eight weeks apart, were made to 90 herds of Danish finisher pigs. The prevalence of clinical signs was recorded by three veterinary technicians from the Danish Bacon and Meat Council according to a standardised procedure; they had been trained and their observations were monitored and validated before and during the study. A total of 154,347 finisher pigs were examined and 22,136 clinical signs were recorded. Vices accounted for 43 per cent of the signs. The highest mean prevalence was observed for ear necrosis (4.44 per cent), followed by respiratory signs (2.17 per cent), lameness (1.92 per cent), other skin diseases (1.73 per cent), tail bites (1.26 per cent), umbilical hernia (0.78 per cent), flank bites (0.52 per cent), diarrhoea (0.27 per cent), respiratory distress (0.12 per cent), atrophic rhinitis (0.10 per cent), recumbency (0.09 per cent) and central nervous disease (0.05 per cent). The prevalence of atrophic rhinitis was higher in conventional herds than in specific pathogen-free herds. The prevalence of clinical signs of atrophic rhinitis was higher among finishers weighing 51 to 75 kg than among finishers weighing up to 50 kg, and the prevalence of respiratory signs was higher among finishers weighing 51 to 75 kg then among finishers weighing 76 to 100 kg.