Tracheal Reconstruction in Dogs

Tracheal reconstruction is a serious surgical procedure used on dogs who have suffered a tracheal collapse. The aim is to reinforce the trachea (windpipe) with a prosthetic structure expanding the windpipe to enable breathing. Although the surgery is used, it is a relatively uncommon procedure and as such, it is often undertaken by a specialist surgeon. Due to the severity of the procedure, it is not taken as a primary measure and is used only for serious cases when other treatment has failed. 

The dog will likely have several visits to try less invasive treatment first. Then an X-ray will be taken to be sure the condition is severe enough to warrant surgery. The dog will then likely be referred to a skilled surgeon. A preliminary meeting will be needed to measure the collapse under fluoroscopy. This will allow the correct size stent and material to be ordered. This usually takes several weeks or months if other treatments were attempted initially. 

Once the diagnosis and referral is complete, the steps that will be taken in the surgical procedure are as follows:

• The dog may have to not eat for a period before to allow for anaesthetic 
• An anti-inflammatory injection may be given to reduce throat swelling
• Intravenous tubes will be inserted and anaesthetic will be administered
• A stent similar to that of a mesh sleeve will be inserted via the endotracheal tube (the mouth) to reinforce the trachea. The stent will not be fitted within 15 mm of the main stem bronchus distally or the larynx proximally 
• Rigid, prosthetic polypropylene rings shaped like the letter ‘C’ may also be inserted inside the trachea to form a tube to keep the airways open 
• The dog will be kept in overnight and monitored

The overall success of this procedure is between 75 and 85%. For those dogs, the procedure will successfully attain its goal of encouraging breathing, increasing mobility and quality of life. However, due to the severity of the surgery many dogs encounter complications and need further surgery. Due to the late stage of the condition, the chance of long term survival (1 to 9 years) is around 50%.

There are aggressive medical management measures that can be taken with the aim to reduce the cough and the tracheal inflammation. To do this, anti-inflammatory medication, cough suppressants and steroids will need to be taken. Bronchodilators and tranquilizers will also need to be taken. However, common side effects from these are depression and constipation. Yet, the real issues with this alternative treatment are two-fold. Firstly, they are palliative, not curative. Secondly, if the collapse is severe they may not be effective enough to relieve pain and enable breathing. 

The dog will usually be kept in for 24 to 48 hours to ensure breathing functionality and to administer pain relief. The dog will need a check-up within two to three weeks of the operation. Any further checkups will be done only if necessary. Signs of clinical improvement are often fairly immediate, although some coughing may persist. Do not be alarmed by snoring, it is usual post-surgery. It may be several weeks to months before the dog has recovered from the surgery, depending on the age, severity of the condition and success of the operation. 

Once returned home, exercise should be kept to a minimum. Exercise can be gradually increased after several weeks. Exposure to excessive heat should also be prevented for two weeks. The owner should feed the dog soft food for the first couple of weeks until the throat and mouth swelling has reduced. Dogs can easily put on weight around the neck which may make breathing more strenuous, so maintenance of weight is essential. A lean physique is vital to continued success.

Tracheal reconstruction can cost anywhere from $3,500 to $6,500. The disparity is for a number of reasons. Firstly, a specialist surgeon is often needed. Many veterinary hospitals do not have the resources and experienced surgeons to carry out this procedure. Another variable is the number of stents needed; one stent can cost up to $1,000. It will also vary depending on how long the dog is kept in to be monitored needing 24/7 care. The anaesthetic alone could cost up to $400.  Also the amount of pain relief needed each week will affect the total price.

The alternative of aggressive medication management to combat tracheal collapse is comparatively less expensive. However, if the dog needs cough suppressants, anti-inflammatory medication, steroids, and tranquilizers, the price of this medication will quickly accumulate. The price will vary depending on the quantity of each that is needed but could cost in excess of a $100 a week. Importantly though, it is not as effective as tracheal reconstruction, which offers a longer-lasting solution. Plus, if the condition is severe, medication alone may not be an effective viable alternative. 

There is the short term implication of a dry cough but cough suppressants could remedy that. Long-term implications could be migration and fracture of the stents, although further stents could be surgically added to combat this. There is also a 10% chance of laryngeal paralysis. There is a possibility of relapse where the trachea could collapse around the stents, but this is unlikely. The implications of this surgery seem severe, but it is due to the serious condition any dog that needs this surgery is already in. By not having the surgery, fatality is likely. This surgery will increase the dog’s lifespan and drastically improve their quality of life. 

The best cure is always prevention. There are a number of proactive measures owners can take to reduce the chances of tracheal collapse taking place:

• Using a chest harness instead of neck leashes will reduce pressure on the trachea. 
• Do not let your dog around second hand smoke. This may have the bonus of discouraging owners from smoking as well. 
• Encourage weight loss with the right diet. Feed them a healthy, balanced diet as recommended by your vet.
• Working in conjunction with a healthy diet is encouraging regular exercise. This will reduce excessive weight which will make breathing more difficult. It will also encourage muscle strength, which in turn will protect from strain on the tracheal area. This will encourage a healthy, active lifestyle for the owner also.
• Discourage over excitement as it may act as a catalyst to an already compromised lung.

A healthy diet and lifestyle will be the most effective long-term preventative measure to take. On top of that, monitoring your dog for a cough or disinterest in exercise will allow you to diagnose any problems early on and increase the efficacy of any treatment.