Repairing a tracheal collapse in dogs

According to Dr. Jim Koch, from Bloomington, Indiana, very few surgeons repair tracheal collapses surgically and there is no straightforward correction. Dr. Koch is unaware of any surgeons in Indiana doing the surgery but there is at least one surgeon in Chicago that does them but only as a last resort. They can be repaired but frequently are not.

What can you do?

Taken from a combination of research and discussions amongst veterinarians at the University of Pennsylvania:

  • The first option is to go for a combination of:
    • aggressive medical management such as steroids, anti-tussives, and/or broncho-dilators
    • reviewing for other causes such as underlying cardiac disease or pulmonary disease, and
    • avoiding neck leashes, encourage weight loss, and no smoking around the pet.
  • If these options do not work, stenting or surgery to implant prosthetic rings are the next option. Both procedures have about 5% mortality rate but have different post-operative and long-terms effects:
    • surgery has 10% chance of laryngeal paralysis (caused by degeneration of the nerves involved in normal breathing) and 20% chance of permanent tracheotomy (half within 24 hours) but has few long term issues if you can get beyond that initial period
    • stents do very well post-operatively but can run into problems longer-term with stent migration, excessive granulation tissue, stent fracture, coughing, and so on
  • Some surgeons prefer stenting if there is intrathoracic collapse (the trachea inside the chest as opposed to the throat part, aka extrathoracic) or the animal is a poor candidate for anesthetic because the death rate for surgical rings in these cases is much higher than stenting.
  • Both stenting and rings have approximate average survivals of about 2-2.5 years according to the scant literature but this depends upon age, other conditions present, and likely the extent of collapse

How much does it cost?

A veterinarian friend told me if the collapse is intrathoracic (low down on the esophagus), you can put stents in the trachea. Depending on how many stents you need, the cost ranges from $3,500 up to $6,500.

Why so much? Apart from the specialist surgeon needed, the stents themselves are $1,000 a piece and the number you need depends on how much of the trachea is collapsed. If the collapse is extra-thoracic you put stents on the outside of the trachea. Cost is about the same.

Your veterinarian can help you understand your choices and their implications more clearly.

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