Intraluminal Tracheal Stenting in Dogs
Primarily for severe tracheal collapse causing respiratory distress in toy breeds of dogs.
- Restores good quality of life to animals suffering severe exercise restriction
- Generally decreases long-term medication requirements.<
- Placed into the trachea via oral approach in lightly anesthetized patient
Side port adapter
- Allows the patient to be intubated so they can receive oxygen under pressure to prevent a crisis due to their tracheal collapse
- Allows the stent to be placed in a controlled fashion, without rush due to oxygen compromise due to collapse
Tracheal Stent Measurements
- On the images to the right, the trachea is the dark tube (air is less dense than tissue and appears darker on radiographs/x-rays) running from the neck to the middle of the chest (it divides just over the heart, the large mostly round structure in the middle of the chest)
- This patient has severe collapse of the cervical (neck) trachea during inspiration (breathing in), but an image take during expiration (breathing out) shows that the entire thoracic (chest) trachea collapses as well.
Digital radiographs (x-rays), fluoroscopy (moving x-ray), and endoscopic evaluation allow important measurements:
Length of collapse
- Portion of the trachea affected by collapse
- Thoracic inlet (where the neck joins the chest) is commonly affected, but some animals are more severely affected in the cervical (neck) or thoracic (chest) portions.
Functional tracheal length
- Almost the entire trachea can be stented, but if you get severe irritation if you get too close to the larynx (voicebox) or carina (where the trachea branches into the mainstem bronchi)
Maximum diameter of the trachea
- Allows selection of a stent to exert the desired radial tension (pressure) on the trachea to stay in place without causing damage
- Measurement performed under positive pressure ventilation to determine how wide the trachea can expand.
Dynamic component of collapse, particularly in the thoracic trachea (within the chest)...see above image, or see the animation video on the tracheal collapse page.
- Length of collapse
- Made of flexible Nitinol (Nickel-Titanium alloy developed by the Naval Ordinance Laboratory)
- Stents can be ordered and obtained overnight if needed
- Stenting from 1cm caudal to cricoid (below/behind the larynx) to 1cm cranial to the carina (where the trachea bifurcates/splits into the two mainstem bronchi) prevents further degeneration/collapse beyond the stent and does not increase complication rate.
- Over 90% of the patients have significant improvement of their function, with most showing marked improvement for years.
- Primary long-term complications include infection and "granulation" (actually inflammatory) tissue, both of which are generally very responsive fluoroquinolone antibiotics (like Baytril or Ciprofloxacin) and a short-course of steroids, respectively.
Earlier reports of higher risks of fracture and migration were associated with inappropriately sized implants.
- Originally thought to be caused by placing a stent that was too long or in an area of motion, such as at that thoracic inlet
- Actually caused by placing a stent that is too wide in diameter; the stents are strongest at their maximal diameter, and if they do not have a chance to expand fully, they are weaker and prone to fracture
Migration is generally caused by placing a stent that is too narrow in diameter
- If the stent is not wide enough to exert sufficient radial force on the trachea, it may not stay in place.
- Heart disease and other systemic factors will negatively impact prognosis.
- I personally consult with the experts at Infiniti Medical on each case, and their feedback helps me choose the ideal stent.
I have been placing intraluminal trachea stents for nearly 10 years, and I have never had a pet suffer long-term from tracheal stent complications.
- Every pet has been markedly improved
- I have not had a stent fracture or migrate
- I have had one confirmed case of inflammatory tissue narrowing the trachea on the cranial (front) edge of the stent, but this resolves completely with tapering steroids and antibiotics.
- Patients typically eventually die from unrelated conditions associated with advanced age or other diseases
- Images courtesy of Dr. Chick Weisse.
Please schedule an appointment with our board-certified surgeon, Dr. Jeff Christiansen at the clinic of your choice, to evaluate your pet and to discuss tracheal stenting to improve your pet's or patient's length and quality of life.
If you have additional questions, please feel free to e-mail Dr. Christiansen directly. For more information on Tracheal Collapse, please consult the trachea stent pages at Infiniti Medical and the ACVS website article on tracheal collapse