New Study: Dual Tracheal Procedures in Dogs Offer Similar Survival to Single Treatments

Combined Endoluminal Stenting and Extraluminal Ring Placement in Dogs Results in Comparable Survival to Historic Data on Singular Interventions

Landon Kobluk, Laura A. Nafe, Jalene Beach, Elizabeth Rozanski, Nicole J. Buote

Background

Tracheal collapse is a progressive degenerative condition in dogs caused by weakening of the tracheal cartilage, leading to airway obstruction and respiratory distress. Tracheal malformation, especially in Yorkshire Terriers, involves W-shaped cartilage rings that resist distension and complicate treatment. While endoluminal tracheal stents (ELS) and extraluminal tracheal rings (ELTR) are both established interventions, their combined use has been rarely reported. This study aimed to evaluate outcomes, complications, and survival in dogs undergoing both ELS and ELTR for tracheal malformation and collapse.

Methods

This retrospective cohort study analyzed medical records from 2005 to 2022 across four veterinary institutions. Nineteen dogs met inclusion criteria, all having undergone both ELS and ELTR, either concurrently or in staged procedures. Data collected included demographics, clinical presentation, imaging, surgical techniques, complications, and survival outcomes. Complications were classified using the Clavien-Dindo system, and Kaplan-Meier survival analysis was performed.

Results

-Nineteen dogs (18 Yorkshire Terriers, 1 Chihuahua) were included, with a median age of 68.5 months and median weight of 3.4 kg. All presented with coughing; 79% were in respiratory distress. Most (88%) had grade IV tracheal collapse with cervical tracheal malformation.

-Procedures: 63% underwent ELTR first, 21% ELS first, and 16% a single-session combination. Median time between staged procedures was 68.5 months.

-Complications: Short-term complications occurred in 36.8% after the initial procedure and 43.8% after the secondary. Long-term complications were common (42% after first, 63% after second). Major complications included stent or ring fracture, granulation tissue formation, progressive collapse, and pneumonia.

-Survival: Median postoperative survival after the last procedure was 13 months (range, 0–75 months). Survival did not differ significantly between dogs with or without major complications. Eighteen of 19 dogs survived to discharge; most deaths were attributed to respiratory disease or collapse recurrence.

Limitations

The retrospective design limited data completeness and consistency across institutions. Small sample size and rare case frequency reduced statistical power. Variability in device types, surgical techniques, and follow-up duration also limited standardization. Some diagnostic data (e.g., tracheal stent position, extent of stenting) were incomplete, and recall bias was possible in owner-reported outcomes.

Conclusions

Dogs with tracheal malformation and collapse managed with combined ELS and ELTR procedures experienced high complication rates but comparable survival outcomes to those undergoing either procedure alone. The combined approach may benefit cases involving rigid malformations, particularly in Yorkshire Terriers, without worsening prognosis. These findings support considering combination therapy as a feasible, case-specific option for severe tracheal disease unresponsive to single-modality treatment.

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