Objective—To develop and determine the feasibility of a novel minimally invasive technique for percutaneous catheterization and embolization of the thoracic duct (PCETD) in dogs and to determine thoricic duct TD pressure at rest and during short-term balloon occlusion of the cranial vena cava (CrVC).
Animals—Fifteen 7- to 11-month-old healthy mixed-breed dogs.
Procedures—Efferent intestinal lymphangiography was performed, and the cisterna chyli was punctured with a trochar needle percutaneously under fluoroscopic guidance. When access was successful, a guide wire was directed into the TD through the needle and a vascular access sheath was advanced over the guide wire. Thoracic duct pressure was measured at rest and during acute balloon occlusion of the CrVC. The TD was then embolized cranial to the diaphragm with a combination of microcoils and cyanoacrylate or ethylene vinyl alcohol.
Results—Successful puncture of the cisterna chyli with advancement of a wire into the TD was possible in 9 of 15 dogs, but successful catheterization was possible in only 5 of 9 dogs. Acute balloon occlusion of the CrVC led to a substantial TD pressure increase in 4 of 4 dogs, and embolization of the TD was successful in 4 of 4 dogs.
Conclusions and Clinical Relevance—PCETD can successfully be performed in healthy dogs; however, this minimally invasive technique cannot currently be recommended for routine treatment of chylothorax, in part because of the technically demanding nature of the procedure. An increase in jugular venous pressure led to an increase in TD pressure, potentially predisposing some dogs to developing chylothorax.
OBJECTIVE To determine risk factors for surgical intervention, complications, and outcome in dogs with an esophageal foreign body (EFB).
DESIGN Retrospective observational study.
ANIMALS 224 incidents of EFB in 223 dogs evaluated at a veterinary teaching hospital from 1995 through 2014.
PROCEDURES Hospital records were reviewed to collect data regarding signalment, history, clinical signs, EFB type and location, procedures, complications, and outcomes. Breed distributions were compared between dogs with EFB and the entire canine patient population during the study period. Variables were tested for associations with each other and with outcomes.
RESULTS Terrier breeds were most common (71/233 [30.5%]). Duration of EFB entrapment, body weight, anorexia, lethargy, rectal temperature, and esophageal perforation were associated with the need for surgical intervention. Older age, longer duration of EFB entrapment, and perforation were associated with a poorer prognosis. Endoscopic retrieval or advancement into the stomach was successful for 183 of 219 (83.6%) EFBs, and 16 of 143 (11.2%) entrapments resulted in postprocedural esophageal stricture. Overall median duration of hospitalization was brief (1 day), and the need for surgical intervention was associated with a longer duration. Overall mortality rate was 5.4% (12/223); 90 of 102 (88.2%) dogs with a median follow-up period of 27 months after EFB treatment had an excellent outcome.
CONCLUSIONS AND CLINICAL RELEVANCE Study findings suggested that endoscopic EFB retrieval remains the initial treatment option of choice for affected dogs, provided that esophageal perforation does not necessitate surgical intervention. Although esophageal stricture formation was the most common complication, the overall rate of this outcome was low.
To compare complications and outcome following unilateral, staged bilateral, and single-stage bilateral ventral bulla osteotomy (VBO) in cats.
282 client-owned cats treated by VBO at 25 veterinary referral and academic hospitals from 2005 through 2016.
Medical records of cats were reviewed to collect information on signalment, clinical signs, diagnostic test results, surgical and postoperative management details, complications (anesthetic, surgical, and postoperative), and outcome. Associations were evaluated among selected variables.
Unilateral, staged bilateral, and single-stage bilateral VBO was performed in 211, 7, and 64 cats, respectively, representing 289 separate procedures. Eighteen (9%), 2 (29%), and 30 (47%) of these cats, respectively, had postoperative respiratory complications. Cats treated with single-stage bilateral VBO were significantly more likely to have severe respiratory complications and surgery-related death than cats treated with other VBO procedures. Overall, 68.2% (n = 197) of the 289 procedures were associated with Horner syndrome (19.4% permanently), 30.1% (87) with head tilt (22.1% permanently), 13.5% (39) with facial nerve paralysis (8.0% permanently), and 6.2% (18) with local disease recurrence. Cats with (vs without) Horner syndrome, head tilt, and facial nerve paralysis before VBO had 2.6, 3.3, and 5.6 times the odds, respectively, of having these conditions permanently.
CONCLUSIONS AND CLINICAL RELEVANCE
Findings suggested that staged bilateral VBO should be recommended over single-stage bilateral VBO for cats with bilateral middle ear disease. Cats with Horner syndrome, head tilt, and facial nerve paralysis before surgery were more likely to have these conditions permanently following surgery than were cats without these conditions.