Tracheal Reconstruction Using a Nitinol Stent for Thoracic Tracheal Rupture

Abstract

Background/aim: Endotracheal tube intubation is required for surgery under inhalation anesthesia. In the present study, after inhalation anesthesia in dogs, the tracheal tube was extubated without deflating the endotracheal tube cuff, resulting in thoracic tracheal rupture, subcutaneous emphysema, and pneumomediastinum. The ruptured thoracic trachea was reconstructed using an endotracheal stent to treat intrathoracic emphysema.

Materials and methods: A double-wire woven nitinol stent was handmade using a cross-and-hook knitting method. The fabricated endotracheal stent was 2-3 mm larger than the internal diameter of the ruptured trachea. The clinical signs and respiratory pattern, image diagnoses (radiography and computed tomography), and tracheoscopy results after endotracheal stenting were assessed for six months.

Results: The lateral cervical radiographs showed that the intratracheal stent was properly placed without migration or stent fracture at the insertion site. After two to three weeks of tracheal stenting, the coughing and dyspnea signs revolved, and the normal activities in all dogs were resumed.

Conclusion: The double-wire braided nitinol stent showed no migration or deformation in the canine trachea. These results suggest that the nitinol stent is compatible with the canine tracheal structure and has flexibility with an adequate radial force.

Keywords: Tracheal rupture; nitinol stent; pneumomediastinum; subcutaneous emphysema.

Figure 1

Radiograph showing a dog with subcutaneous emphysema (arrow) and pneumomediastinum caused by an air leak from the thoracic trachea.

Figure 2

A computed tomography scan of the thoracic cavity, revealing a ruptured thoracic trachea (white arrow) and severe subcutaneous emphysema.

Figure 3

Images of a canine tracheoscopy (A) and computed tomography scan (B) 10 weeks after the placement of an endotracheal stent (white arrows). Radiopaque markers were attached to both ends and above and below the stent to identify its location in the trachea (black arrows).