Rings or stents?
The placement of either tracheal rings (Photo 2a) or a tracheal stent (Photo 2b) remains one of the most difficult and controversial
decisions regarding the treatment of this disease. The choice of tracheal rings vs. tracheal stent should be made on an individual
basis. I use the following guidelines for animals that have failed aggressive medical management:
- Young, otherwise healthy patients with cervical collapse alone: Consider tracheal rings.
- Any debilitated patients that are a considerable anesthetic risk: Consider tracheal stent.
- Animals with diffuse tracheal collapse: Consider either a single tracheal stent or combination of cervical rings and intrathoracic
Although there is minimal literature available assessing outcomes following these procedures, I provide the following information
to pet owners to help them make a decision:
Tracheal rings (Photo 3) have been associated with a 75 percent to 85 percent success rate, but also with approximately 5
percent surgical mortality, 10 percent laryngeal paralysis and 20 percent permanent tracheo-stomy placement. Intrathoracic
ring placement (beyond the first or second intercostal space) is associated with excessive morbidity, and is not currently
recommended for patients with intrathoracic collapse.
Photo 3: Intra-operative images demonstrating placement of external tracheal rings to provide support for a collapsing trachea.
Tracheal stents (Photo 4) have a 75 percent to 90 percent success rate, but also carry a reported 5 percent to 10 percent
mortality rate (which is greater than my experience). Short-term complications typically are minor and minimal, but long-term
complications include uncertain risk of stent fracture, inflammatory tissue development at the stent ends and a low risk (when
placed appropriately) of stent migration.
Photo 4: Lateral fluoroscopic images demonstrating esophageal marker catheter and severe diffuse tracheal collapse, before
(above) and immediately following placement of an intraluminal tracheal stent (below).
Regardless of the treatment used, considerable discussion with the client is important to ensure outcome expectations are
clear. Tracheal collapse is a progressive disease, and all current treatments are palliative. The majority of patients will
require lifelong medical treatment following stenting.
In addition, it is my opinion that concurrent bronchial collapse appears to carry a worse long-term prognosis; however, this
does mean the patient may not benefit from one of these treatments.
It is important to appreciate that the outcomes of tracheal rings and tracheal stenting cannot easily be evaluated against
one another; these are treatments for patients with very different extents of disease and prognoses.
Dr. Weisse is an ACVS board-certified veterinary surgeon with a research interest in interventional radiology techniques.
He is currently director of the Interventional Radiology Service and assistant professor of surgery at the Veterinary Hospital
of the University of Pennsylvania and he has a dual appointment in the department of radiology at the Hospital of the University