Extraluminal nitinol prosthesis in the treatment of intrathoracic tracheal collapse in a dog / Uso de prótese extraluminal de nitinol no tratamento de colapso traqueal intratorácico em um cão

A six-month-old male Brazilian Terrier with persistent cough and dyspnea was diagnosed with intrathoracic tracheal collapse and pneumonia after chest radiographics. The medical treatment was performed, and an extraluminal nitinol prosthesis was placed through thoracic access. The dog did not presented recurrence of dyspnea or pneumonia for four years after the surgical procedure. Placement of the extraluminal prosthesis with the thoracic approach effectively stabilized intrathoracic tracheal collapse without causing any structural damage in the thoracic region. Therefore, this is the first report of a successful use of this prosthesis with an intercostal approach in dogs for intrathoracic trachea collapse.

Um cão macho, da raça Terrier Brasileiro de seis meses de idade, com dispnéia e tosse persistente foi diagnosticado com colapso traqueal intratorácico e pneumonia após estudo radiográfico de tórax. Foi instituído tratamento médico e realizada toracotomia para a implantação de prótese traqueal extraluminal de nitinol. O animal não manifestou dispneia ou pneumonia durante os quatro anos posteriores ao procedimento. A implantação da prótese extraluminal através da toracotomia foi eficaz para o tratamento do colapso traqueal intratorácico, sem provocar danos estruturais na região torácica. Desta forma, este é primeiro relato da utilização bem-sucedida deste tipo de prótese, a partir da abordagem intercostal, no tratamento de cães com colapso traqueal intratorácico.

New technique for intrathoracic implantation of extraluminal spiral prostheses in the trachea

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications. Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral le-sions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy find-ings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was...

New technique for intrathoracic implantation of extraluminal spiral prostheses in the trachea

Background: Extraluminal surgical procedures for intrathoracic tracheal collapse in dogs are not routinely performed. The patients are normally treated with different drugs or by intraluminal stents. However, in more severe cases, drug treatment does not always have good outcomes, and intraluminal prostheses can be correlated to several postoperative problems. In order to obtain better results, we aimed to develop a surgical technique for implantation of a new extraluminal helical prosthesis in the thoracic segment of the trachea through cervical access, associated with pneumatic mediastinoscopy for certification of the technique and minimization of possible complications. Materials, Methods & Results: Seven canine corpses (CCs) from non-traumatic death, weighing between 2 and 7 kg, were used. A ventral cervical approach to the trachea was associated with blunt mediastinal dissection. Trans cervical pneumatic mediastinoscopy was used for evaluation of the dissection and location of the implant. These were compared with the necropsy findings by the exact Wilcoxon two-sample test, with P < 0.05. The results of necropsy and mediastinoscopy did not present significant differences at P < 0.05. During the examinations, the presence of some mediastinal visceral le-sions caused by the prosthesis, the integrity of the mediastinum and possible lesions to RLN and blood vessels (BV) were analyzed. We also investigated the location of the distal part of the prosthesis in the thoracic segment of the trachea and its dissection. To evaluate the technique, statistical comparison was made between mediastinoscopy and necropsy find-ings. The data were compared by the Wilcoxon test at 5% probability. The tracheas of all CCs were efficiently dissected, but in some cases problems that can happen during the procedure were noticed. This was checked by mediastinoscopy and confirmed by necropsy. The median of the scores was...(AU)

Laceração de traqueia em cão – Relato de Caso / Laceration of Trachea in dog - Case report

Tracheal laceration can have several causes, among them by run over, bite, projectile andiatrogeny. Tracheal lesions, although uncommon in companion animals, deserve specialattention, since, depending on the severity, they may cause death to the affected patients.The treatment may be conservative or surgical, being the choice dependent on thepresentation of the patient. This study is a case report of a laceration of the trachea in a dogby trampling, whose treatment of choice was the surgical one due to the critical state inwhich the animal presented itself. It all went well, the animal recovered quickly and well.

Laceração de traqueia em cão Relato de Caso / Laceration of Trachea in dog - Case report

Tracheal laceration can have several causes, among them by run over, bite, projectile andiatrogeny. Tracheal lesions, although uncommon in companion animals, deserve specialattention, since, depending on the severity, they may cause death to the affected patients.The treatment may be conservative or surgical, being the choice dependent on thepresentation of the patient. This study is a case report of a laceration of the trachea in a dogby trampling, whose treatment of choice was the surgical one due to the critical state inwhich the animal presented itself. It all went well, the animal recovered quickly and well.(AU)

Stent placed by endoscopy for the treatment of tracheal obstruction caused by a tumor in a domestic cat

Background: Tracheal tumors are rare and may cause obstruction of the trachea. The neoplasms most commonly diagnosed in cats are lymphosarcoma, squamous cell carcinomas and adenocarcinomas. Surgical resection may provide a clinical cure for small, benign and localized tumors. For malignant neoplasia, surgery is usually palliative. Tracheal segment excision is an invasive procedure, particularly when the intrathoracic trachea is involved, and this increases the risk of stenosis, surgical suture dehiscence, necrosis and pneumothorax. Intraluminal tracheal stents have been used in dogs with tracheobronchomalacia, presenting a feasible alternative to surgery for the treatment of tracheal lumen obstruction. Case: A 11-year-old male mixed-breed cat was referred to the Veterinary Hospital of the Federal University of Rio Grande do Sul (HCV-UFRGS) with a history of appetite loss, wasting and progressive inspiratory dyspnea, for the last 30 days. The cat presenting with oral breathing. Radiography of the lateral thorax shown a radiopaque area, 1cm in diameter, superimposed in the tracheal region, close to the carina cartilage, at the fourth intercostal space. A tracheoscopy confirmed the diagnosis of tracheal neoplasia, which was identified as an adenocarcinoma by biopsy and histopathology. Given that surgical resection may result in significant morbidity and consequent mortality, the owner chose a palliative treatment without adjuvant therapy for adenocarcinoma until acquisition of the stent, with partial resection of the tumor performed during tracheoscopy. This procedure was performed twice at an interval of three months. After the first endoscopic examination, the patient regained weight and normal behavior. Three months after the second tracheoscopy, signs of labored breathing recurred. At this point, the obstruction was treated with implantation of an intratracheal stent. A nitinol biliary stent, 35 mm in length, 8 mm in diameter, was applied during tracheoscopy without fluoroscopy aid. The cat received postoperative treatment with dexamethasone 0.25 mg.kg­¹ SID for seven days. The patient showed immediate clinical improvement in dyspnea, but retained an episodic cough. After six months, the cat suffered a relapse of dyspnea. Radiographic examination revealed a large area of radiopacity in the region of the tracheal stent, suggesting an increase in size of the tumor, and possible metastasis in the lung parenchyma. The patient underwent repeat tracheoscopy, and almost complete obstruction of the tracheal lumen was found. The cat died during this procedure. Post-mortem examination was requested, which confirmed tracheal obstruction resulting from growth of the tumor, and pulmonary metastasis. Discussion: There are few reports of tracheal neoplasms in cats, because they are uncommon. The diagnosis was based on radiography, tracheoscopy and incisional biopsy. Treatment with surgery involves high morbidity and mortality. For this reason we chose the use of a tracheal stent, although palliative in cases of cancer. Stents are frequently used in humans with malignant tracheal obstruction, but the few reports in the veterinary literature, are focused on dogs presenting with tracheobronchomalacia. In cats, a few cases of tracheal stenosis and tumors have been treated experimentally with stents, which have shown success in reestablishing an airway. In previous reports, the technique has always been carried out with the aid of fluoroscopy. The application of the stent using tracheoscopy alone was efficient. The patient in this report suvived for one year since it diagnosed before near-total obstruction of the trachea occurred. Therefore this was a palliative measure, which allowed the patient a good quality of life while receiving adjuvant therapy when possible or necessary.

Cryopreserved tracheal segments: a new tool for bench surgical training in thoracic surgery / Segmentos criopreservados de traqueia: uma nova ferramenta para auxiliar o treinamento na cirurgia torácica

PURPOSE: To present a new low-cost high fidelity bench model of cryopreserved trachea that can be used to learn surgical skills from medical students to cardiothoracic surgery fellows. METHODS: Ten tracheas were harvested from ten non-trachea related research dogs at the moment of euthanasia. Each trachea was trimmed in six or seven rings segments. They were cryopreserved and stored during 60 days. The day programmed for surgical skills practice, they were thawed to room temperature. RESULTS: Forty segments have been used. After defrosting, all the segments kept their normal anatomic shape and structural integrity. Two incisions were made on every tracheal segment and sutured with running or separate stitches with 5-0 polypropilene. There were no complications such as cartilage ruptures, neither tears on the mucosae, the cartilages nor the membranous posterior membrane. CONCLUSIONS: The cryopreserved trachea is a high fidelity, practical, reproducible, portable, low-cost bench model. It allows cardiothoracic fellows to learn how to handle a trachea, as well as to perfect their surgical and suture abilities before applying them on a real patient's trachea.(AU)

OBJETIVO: Apresentar novo modelo de traquéia criopreservada de baixo custo e alta fidelidade que pode ser usado tanto por estudantes de medicina como por cirurgiões cardiotorácicos no aprendizado e desenvolvimento de suas habilidades cirúrgicas. MÉTODOS: Foram coletados amostras de dez traquéias de dez cães utilizados para pesquisa após a eutanásia. Cada segmento de traquéia foi dividida em seis ou sete anéis, criopreservadas e armazenadas durante 60 dias. No dia programado para a prática cirúrgica os segmentos foram descongelados a temperatura ambiente. RESULTADOS: Foram utilizados 40 segmentos no estudo. Após o descongelamento todos os segmentos mantiveram sua forma anatômica e sua integridade estrutural. Foram realizadas duas incisões em cada segmento traqueal que foram suturadas em padrão continuo ou com pontos separados utilizando sutura de polipropileno 5-0. Não houve nenhuma complicação como a ruptura da cartilagem, rasgos na mucosa, cartilagem ou na membrana membranosa posterior. CONCLUSÕES: O modelo de traquéia criopreservada é altamente fidedigno, prático, reproduzível, portátil e de baixo custo. Permite que os cirurgiões cardiotorácicos aprendam como manipular a traquéia, assim como aperfeiçoar suas habilidades cirúrgicas antes de sua aplicação em traquéias de pacientes reais.(AU)

Ruptura traqueal em um cão - relato de caso / Tracheal rupture in a dog - case report / Ruptura traqueal en un perro - relato de caso

As alterações na traqueia cervical de cães e gatos provocam dificuldades respiratórias e podem ser decorrentes de tumor, corpo estranho, colapso traqueal, hipoplasia, estenose segmentar, estenose pós-intubação prolongada e traumatismo. Este último, no entanto, constitui a principal causa de ruptura ou estenose traqueal, podendo ser causado por briga entre animais ou por lesões penetrantes. As lacerações podem causar enfisema subcutâneo e mediastínico significativo. Objetiva-se com este trabalho relatar o caso de um cão sem raça definida de três anos de idade, com histórico de briga com outro cão dois dias antes, sem escoriações no corpo, mas apresentando enfisema subcutâneo generalizado. Após o diagnóstico de ruptura traqueal traumática, o animal foi submetido a traqueoplastia. A técnica se mostrou exequível e uma ótima opção em casos de pequenas lacerações.

Changes in the cervical trachea in dogs and cats cause breathing difficulties and could be due to tumors, foreign bodies, tracheal collapse, hypoplasia, segmental stenosis, prolonged post-intubation stenosis and injuries. The latter, however, is the main cause of breakage or tracheal stenosis, and may be caused by fighting among animals or penetrating injuries. Lacerations can cause significant subcutaneous and mediastinal emphysema. This work reports the case of a three-year-old mixed-breed dog with generalized subcutaneous emphysema and a two-day history of fight with another dog. The animal had no head injuries and was diagnosed with traumatic tracheal rupture, being submitted to tracheoplasty. The technique proved feasible and a great option for small lacerations.

Las alteraciones de la traquea cervical en perros y gatos provocan dificultades respiratorias y pueden estar asociadas a tumores, cuerpos extranos, colapso traqueal, hipoplasia, estenosis segmentaria, estenosis postintubación prolongada y traumatismo. Los traumas traqueales representan la principal causa de ruptura o estenosis de traquea, y pueden estar ocasionados por peleas entre animales o por lesiones penetrantes. Las laceraciones pueden causar un importante enfisema subcutáneo y mediastínico. El objetivo del presente trabajo es relatar el caso de un perro mestizo de tres anos, con historia de pelea con otro perro dos días antes de la consulta, sin lesiones corporales visibles, que presentaba un enfisema subcutáneo generalizado. Después del diagnóstico de ruptura traqueal traumática, se realizó una traqueoplastia. La técnica demostró ser viable en cuanto a su ejecución, representando una excelente opción terapéutica en casos de pequenas laceraciones.

Ruptura traqueal em um cão - relato de caso / Tracheal rupture in a dog - case report / Ruptura traqueal en un perro - relato de caso

As alterações na traqueia cervical de cães e gatos provocam dificuldades respiratórias e podem ser decorrentes de tumor, corpo estranho, colapso traqueal, hipoplasia, estenose segmentar, estenose pós-intubação prolongada e traumatismo. Este último, no entanto, constitui a principal causa de ruptura ou estenose traqueal, podendo ser causado por briga entre animais ou por lesões penetrantes. As lacerações podem causar enfisema subcutâneo e mediastínico significativo. Objetiva-se com este trabalho relatar o caso de um cão sem raça definida de três anos de idade, com histórico de briga com outro cão dois dias antes, sem escoriações no corpo, mas apresentando enfisema subcutâneo generalizado. Após o diagnóstico de ruptura traqueal traumática, o animal foi submetido a traqueoplastia. A técnica se mostrou exequível e uma ótima opção em casos de pequenas lacerações.(AU)

Changes in the cervical trachea in dogs and cats cause breathing difficulties and could be due to tumors, foreign bodies, tracheal collapse, hypoplasia, segmental stenosis, prolonged post-intubation stenosis and injuries. The latter, however, is the main cause of breakage or tracheal stenosis, and may be caused by fighting among animals or penetrating injuries. Lacerations can cause significant subcutaneous and mediastinal emphysema. This work reports the case of a three-year-old mixed-breed dog with generalized subcutaneous emphysema and a two-day history of fight with another dog. The animal had no head injuries and was diagnosed with traumatic tracheal rupture, being submitted to tracheoplasty. The technique proved feasible and a great option for small lacerations.(AU)

Las alteraciones de la traquea cervical en perros y gatos provocan dificultades respiratorias y pueden estar asociadas a tumores, cuerpos extranos, colapso traqueal, hipoplasia, estenosis segmentaria, estenosis postintubación prolongada y traumatismo. Los traumas traqueales representan la principal causa de ruptura o estenosis de traquea, y pueden estar ocasionados por peleas entre animales o por lesiones penetrantes. Las laceraciones pueden causar un importante enfisema subcutáneo y mediastínico. El objetivo del presente trabajo es relatar el caso de un perro mestizo de tres anos, con historia de pelea con otro perro dos días antes de la consulta, sin lesiones corporales visibles, que presentaba un enfisema subcutáneo generalizado. Después del diagnóstico de ruptura traqueal traumática, se realizó una traqueoplastia. La técnica demostró ser viable en cuanto a su ejecución, representando una excelente opción terapéutica en casos de pequenas laceraciones.(AU)