Tracheal collapse has traditionally been treated surgically through the placement of prosthetic tracheal rings around the trachea to support it from the outside. We offer tracheal stent placement for dogs with tracheal collapse. Tracheal stent placement avoids surgery and is associated with a far lower acute complication rate than standard surgical treatment. The procedure is painless and animal normally return home the following day. Dogs with tracheal collapse will be assessed using physical examination findings and fluoroscopy (real-time x-ray). Ongoing medical management, prosthetic ring placement, and tracheal stent placement all have their place in the management of this challenging disease process. The best treatment recommendations will be made for your pet based on the extent and location of collapse.
Tracheal Tumors / Strictures: Traditionally treated through surgical resection, tracheal stent placement offers a non-surgical option for palliation of clinical signs associated with these conditions.
Tracheal or Bronchial Foreign Body Retrieval may be performed using fluoroscopic guidance.
Chronic Pleural Effusion (accumulation of fluid around the lungs): Chronic pleural effusion is a life-limiting condition encountered due to chylothorax and various types of cancer. IR techniques are utilized to place indwelling drains in a non-surgical fashion linked to subcutaneous access ports allowing clients and their veterinarians to remove this fluid on a chronic basis without the need for painful repeated thoracocentesis (use of a needle or catheter to remove fluid from the chest).
Cardiovascular Interventions
Vascular foreign body retrieval. The most common vascular foreign body is an IV catheter that has broken off or is severed and is lodged in the pulmonary vasculature. Using fluoroscopic guidance, vascular foreign bodies can be retrieved without the need for surgery.
Pericardial Drain Placement: Pericardial drains are often placed on an emergency basis in animals with cardiac tumors that cause bleeding into the sac around the heart. The drain allows for the removal of this blood allowing cardiac function to return to normal. The drain is most often used as a bridge to surgical resection of these tumors.
Balloon Pericardiotomy: Balloon pericardiotomy (creating a hole in the pericardium using a balloon under fluoroscopic guidance) is a minimally invasive approach to the long-term management of pericardial effusion (accumulation of fluid in the sac around the heart) due to certain types of cancer and idiopathic causes. Balloon pericardiotomy is inferior to pericardectomy (surgical removal of the pericardium) and thoracoscopic pericardial window (removing a “window” of the pericardium to allow fluid to drain), however, it is much less invasive and can result in sustained improvement in clinical signs.
Diagnostic Angiography Studies: The IR service performs a variety of angiographic studies for the diagnosis and subsequent treatment of a variety of vascular anomalies including developmental anomalies, peripheral venous malformations, arterio-venous malformations, thromboembolic diseases (blood clots), vascular occlusions due to tumors, etc.
Vascular Stenting and Angioplasty: Angioplasty and vascular stenting may be indicated for obstructed blood vessels due to tumors, clots, or other abnormalities. The IR Service is able to perform diagnostic studies and then therapeutic procedures to alleviate or palliate these conditions.
The MSU Cardiology Service is equipped for the diagnosis and treatment of a variety of developmental cardiac diseases of dogs and cats in a minimally invasive fashion (balloon valvuloplasty, cardiac catheterization).
Urogenital Interventions
Urethral Stent Placement: Dogs (and rarely cats) develop cancer that can cause partial obstruction of the bladder or the urethra making it difficult for them to urinate. Traditional treatment focused on placement of an indwelling tube into the bladder (cystostomy) via a surgical approach. Placement of a urethral stent across the narrowed region can restore urination in these patients without the need for any surgical procedure, the complications (chronic infections) that accompany it or the challenges that owners have to endure to intermittently drain the urine from the cystostomy tube. Placement of the urethral stent treats the clinical sign of difficulty urinating. The IR Service and Oncology Service work closely on these cases. The Oncology Service will develop a long-term treatment plan and present you with options for specific treatment of the tumor itself.
Percutaneous Nephrostomy Tube Placement: A percutaneous nephrostomy tube is a tube that is used to divert urine from the kidney to the outside when the ureter (located between the kidney and bladder) is obstructed. Ureteral obstruction most often results from stones, infection, and tumors of the bladder. The procedure is performed under a short anesthesia and eliminates the need for emergency surgery in these often critically ill patients until a time when they are more stable and better surgical candidates.
Ureteral Stent Placement: Ureteral stents are placed using a combination of IR and endoscopy techniques to allow urine to pass between the kidney and the bladder when an obstruction is present that is not amenable to surgery or when the client wishes to attempt to avoid surgical intervention. These procedures are performed with Dr. John Kruger who is an internist with extensive experience and expertise in endourology.
Intra-arterial chemotherapy: Intra-arterial chemotherapy is designed to deliver large doses of chemotherapy directly into the major blood vessels feeding a given tumor. Bladder, urethra, prostate, and intrapelvic tumors of other origin may be amenable to this treatment approach. Please see Oncology Applications below for additional applications of IR procedures in the treatment of tumors.
Antegrade Urethral Access: Antegrade urethral access is a technique that is utilized to facilitate placement of a catheter in the bladder when routine placement techniques fail due to the size of the patient, the presence of a tumor, or from a tear in the urethra. This technique is very quick and simple to perform and allows the clinicians of the IR Service to avoid surgical interventions that would normally be necessary to resolve many of these problems (surgical cystostomy tube placement, perineal urethrostomy for urethral tear or surgical placement of a urinary catheter).
Portosystemic Shunt Treatment
Background: Dogs of all sizes are occasionally born with an abnormal communication of blood vessels in the liver (intrahepatic) or outside the liver (extrahepatic) that diverts blood flow around, rather than through the liver. The clinical signs resulting from this developmental problem include failure to grow and thrive, lethargy, depression, and abnormal behaviors including but not limited to blindness, tremors, seizures, star gazing, head pressing, and ataxia (being off balance). Extrahepatic shunts are most common in small breed dogs (especially Pugs and Yorkshire Terriers). Surgery is most often indicated in these patients and is highly successful. Intrahepatic shunts (IHPSS) are most common in larger breed dogs. Breed dispositions include the Labrador Retriever, Flat-Coat Retriever, Irish Wolfhound, and Bernese Mountain Dog, but all breeds may be affected (including the rare small breed). Traditional treatment of intrahepatic shunt has also been surgical using a variety of different techniques and devices. However, the shunt is often difficult to identify within the liver, challenging to dissect, and challenging to partially occlude. Frequently a second surgical procedure is necessary later in the life when the process must be repeated. The procedures have also been associated with unacceptably high complication rates including death (7-66% perioperative death rates have been reported). An endovascular (inside the vessel) repair technique has been developed and perfected that eliminates the need for open surgery, eliminates patient pain and discomfort associated with surgery, shortens hospitalization, and is associated with a very low perioperative mortality rate <5%). MSU has never lost a patient in the perioperative period. Instead of opening the abdomen and part of the chest to make the repair, the entire procedure is performed using catheters, stents, and coils from within the blood vessels themselves. The entire procedure is performed via a <5mm incision over the jugular vein in the neck. The procedure is called a Percutaneous Transjugular Coil Embolization (PTCE).
Percutaneous Transjugular Coil Embolization (PTCE): MSU VMC is one of only three centers in the country offering this revolutionary treatment. A true team approach to treatment is needed for success. We work closely with the Anesthesia team during the PTCE procedure. The procedure is technically demanding and requires a familiarity with a variety of different techniques, equipment, and materials. Dr. Beal has performed more of these procedures successfully than any other veterinarian in the world with the exception of the Team of Drs. Weisse and Berent at the University of Pennsylvania with whom he did his training. If you or your veterinarian believes that your dog may have IHPSS, please call Drs. Beal and Mehler for consultation. We will help your veterinarian in the medical stabilization of the condition through medication and dietary modification. Once stable, your dog will be admitted to the hospital and a CT scan performed to identify the exact anatomy of the shunt. The PTCE procedure is performed days to a few weeks in the future. The CT and PTCE cannot be performed on the same day because of the contrast agents utilized and the risks that a high dose of contrast in a single procedure could provide.
Oncologic Applications
Transarterial Chemoembolization (TACE): For non-resectable liver tumors.
Transarterial Chemotherapy or Embolization: For palliative treatment of unresectable neoplastic disease. Example: Embolization for pain control for metastatic or primary bone tumors. Potential delivery of chemotherapy as a radiation sensitizer.
Stenting of malignant urethral or ureteral obstruction (see above)
Stenting of malignant vascular obstruction
Stenting of malignant airway obstruction when surgery is contraindicated or not desired.
Stenting of malignant gastrointestinal obstruction when surgery is contraindicated or not desired.
Subcutaneous Vascular Access Port (SVAP) placement
Nutritional Applications
Nasojejunal (NJ) feeding tube placement using IR techniques. Placement of the NJ tube allows for enteral nutritional support in animals with critical illness and vomiting or regurgitation. Feeding directly into the gastrointestinal system has been conclusively shown to be superior to parenteral routes of nutritional support (Total Parenteral Nutrition (TPN))
Percutaneous gastrostomy tube placement
Percutaneous gastrojejunostomy tube placement
Esophagojejunostomy tube placement
Miscellaneous Procedures
Glue embolization of hepatic arteriovenous malformations
Glue embolization of thoracic duct
Biliary drainages
Esophageal stricture stenting (in concert with balloon dilation to decrease necessity for repeated dilations).
Nasal embolization for intractable epistaxis. Unlike carotid artery ligation, this procedure may be repeated as needed.
Repair of complex vascular malformations
Subcutaneous Vascular Access Port (SVAP) placement
Miscellaneous drainages
Indwelling drainage catheters with subcutaneous access port
