Tracheal Stenting for Tracheal Collapse


Dr Paolo Pazzi, BVSc MMedVet (Med), Small Animals

Diplomate ECVIAM (CA), Faculty of Vet Sc., UP

Dr Anri Celliers, BVSc MMedVet (Med), Small Animals
Faculty of Vet Sc., UP

Tracheal collapse is a progressive, diffuse disease that can affect the trachea, mainstem bronchi and bronchioles.  It occurs mainly in middle-aged toy- and small-breed dogs, with Yorkshire terriers representing up to two-thirds of cases.  The cause of tracheal collapse is multifactorial, but of primary importance is weakening of the tracheal rings secondary to a reduction in glycosaminoglycans as well as laxity of the dorsal tracheal membrane resulting in dorsoventral flattening of the trachea.

Secondary factors associated with the onset of clinical signs are: obesity, chronic bronchitis, laryngeal paralysis, respiratory tract infections and airway irritants.  Once dogs become symptomatic for tracheal collapse, the cycle of airway inflammation is constantly perpetuated by coughing

Treatment of tracheal collapse, whether it be medical or surgical, is palliative, but can result in dramatic improvement in the patient’s quality of life and be lifesaving in cases where there is severe respiratory distress.  Treatment options can be tailored for the four different presentations of tracheal collapse as follows:

  1. Patients which mainly present with coughing and very little or no signs of airway obstruction are poor candidates for tracheal stenting and are primarily medically managed.
  2. Patients which present with signs of airway obstruction are candidates for tracheal stenting, assuming medical therapy has failed by this point.
  3. Patients which present with both airway obstruction and a severe cough are candidates for surgical intervention if medical management has failed.
  4. Patients which present with a fixed airway obstruction due to tracheal ring malformation/inversion (“w” shaped trachea), causing inspiratory and expiratory dyspnoea, are poor candidates for intraluminal stenting, due to insufficient contact with the tracheal mucosa.  In these cases, prosthetic ring placement should be considered.

 

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