Gastrointestinal angiodysplasias diagnosed using video capsule endoscopy in 15 dogs.

BACKGROUND: Angiodysplasia (AGD) is rarely diagnosed in dogs with gastrointestinal bleeding (GIB) and is reported in case reports in dogs. OBJECTIVE: Describe signalment, clinical and diagnostic features of dogs with gastrointestinal (GI) AGD diagnosed by video capsule endoscopy (VCE). ANIMALS: Dogs with overt or suspected GIB which underwent VCE. METHODS: Dogs for which a VCE was submitted for overt or suspected GIB from 2016 to 2021 were selected retrospectively. Medical records and full-length VCE recordings where AGDs were initially detected, were reviewed by 2 trained internists. AGD was considered definitive if 2 readers detected it. Signalment, clinical signs, blood work, medications, concurrent diseases, findings of previous conventional endoscopy, and surgical exploration (if applicable) of dogs with AGD were recorded. RESULTS: Definitive AGD was diagnosed in 15 of 291 (5%) dogs (12 males, 3 females). Twelve (80%) had overt GIB, 11 (73%) had hematochezia, and 6 (40%) had microcytic and hypochromic anemia. AGD was missed by conventional endoscopy in 9/9 dogs and exploratory surgery in 3/3 dogs. Thirteen capsules were administered by mouth (1 incomplete study), and 2 via endoscopy directly into the duodenum. AGD was visualized in the stomach of 3 dogs, in the small intestine of 4, and in the colon of 13 dogs. CONCLUSION AND CLINICAL IMPORTANCE: Although rare, AGD should be considered in dogs with suspected GIB after a negative conventional endoscopy or surgical exporation. Video capsuel endoscopy appears to be a sensitive test to identify AGD within the GI tract.

Multiple gastric erosions diagnosed by means of capsule endoscopy in a dog.

CASE DESCRIPTION A 6-year-old spayed female Golden Retriever was evaluated for a 2-week history of progressive hyporexia, signs of abdominal pain, and weight loss. CLINICAL FINDINGS Physical examination findings included mild signs of pain on palpation of the cranial part of the abdomen and a body condition score of 4 (scale, 1 to 9). A CBC revealed mild microcytosis and hypochromasia; results of serum biochemical analysis were within the respective reference ranges, and abdominal ultrasonography revealed no abnormalities. Capsule endoscopy was performed, and numerous gastric erosions and hemorrhages were detected, with rare dilated lacteals in the proximal aspect of the small intestine. TREATMENT AND OUTCOME Treatment was initiated with omeprazole and sucralfate for 6 weeks, and the dog was transitioned to a novel protein diet. Capsule endoscopy was repeated at the end of the initial treatment course and revealed overall improvement, with a few small erosions remaining; medical treatment was continued for an additional 2 weeks. At last follow-up 9 months after treatment ended, the dog was clinically normal. CLINICAL RELEVANCE Capsule endoscopy was useful for initial detection and subsequent reevaluation of gastrointestinal lesions in this patient without a need for sedation or anesthesia. Information obtained in the follow-up evaluation was valuable in identifying a need to extend the duration of medical treatment.

Collateral circulation in ferrets (Mustela putorius) during temporary occlusion of the caudal vena cava.

OBJECTIVE To determine whether extent of collateral circulation would change during temporary occlusion of the caudal vena cava (CVC) in ferrets (Mustela putorius), a pressure change would occur caudal to the occlusion, and differences would exist between the sexes with respect to those changes. ANIMALS 8 adult ferrets (4 castrated males and 4 spayed females). PROCEDURES Ferrets were anesthetized. A balloon occlusion catheter was introduced through a jugular vein, passed into the CVC by use of fluoroscopy, positioned cranial to the right renal vein, and inflated for 20 minutes. Venography was performed 5 and 15 minutes after occlusion. Pressure in the CVC caudal to the occlusion was measured continuously. A CBC, plasma biochemical analysis, and urinalysis were performed immediately after the procedure and 2 or 3 days later. RESULTS All 8 ferrets survived the procedure; no differences were apparent between the sexes. Vessels providing collateral circulation were identified in all ferrets, indicating blood flow to the paravertebral venous plexus. Complications observed prior to occlusion included atrial and ventricular premature contractions. Complications after occlusion included bradycardia, seizures, and extravasation of contrast medium. Mean baseline CVC pressure was 5.4 cm H2O. During occlusion, 6 ferrets had a moderate increase in CVC pressure (mean, 24.3 cm H2O) and 2 ferrets had a marked increase in CVC pressure to > 55.0 cm H2O. CONCLUSIONS AND CLINICAL RELEVANCE Caval occlusion for 20 minutes was performed in healthy ferrets with minimal adverse effects noted within the follow-up period and no apparent differences between sexes. The CVC pressure during occlusion may be prognostic in ferrets undergoing surgical ligation of the CVC, which commonly occurs during adrenal tumor resection.

Transcatheter arterial embolization for treatment of hepatocellular carcinoma in a cat.

CASE DESCRIPTION: A 16-year-old 6.8-kg (15-lb) castrated male domestic shorthair cat was evaluated because of a 3 × 6-cm mass in the right medial lobe of the liver. CLINICAL FINDINGS: The cat had a history of frequent vomiting and anorexia along with 10% weight loss over the past year. TREATMENT AND OUTCOME: Transcatheter arterial embolization was selected because surgery (standard first-line treatment) was declined and only 1 vessel feeding the tumor was apparent on contrast-enhanced CT. A 4F sheath was placed in the left carotid artery, and a 3.3F guide catheter was advanced into the celiac artery. A 0.014-inch guidewire and 1.7F microcatheter were inserted into the hepatic artery through the guiding catheter and advanced into the feeding vessel. A mixture of polyvinyl alcohol particles and contrast agent was injected for embolization. A hypoechoic area in the tumor was identified on ultrasonography on posttreatment day 6, and necrotic and degenerated cells in the area were identified cytologically. By posttreatment day 71, vomiting had resolved and CT revealed decreased tumor size, but altered attenuation suggested a more solid mass on day 205. No feeding vessel for embolization was found on contrast-enhanced CT, so ultrasonic emulsification to remove the tumor was performed on day 231. No recurrence was seen on contrast-enhanced CT on day 420 or day 721. CLINICAL RELEVANCE: Findings suggested that transcatheter arterial embolization may be suitable for treating hepatic tumors in cats, but alternative approaches are needed in cats, compared with dogs, owing to anatomic differences.

Endovascular evaluation and treatment of intrahepatic portosystemic shunts in dogs: 100 cases (2001-2011).

OBJECTIVE: To evaluate short- and long-term outcome following endovascular treatment of intrahepatic portosystemic shunts in dogs. DESIGN: Retrospective case series. ANIMALS: 100 dogs. PROCEDURES: All patients had angiographic evaluation with or without endovascular shunt attenuation. The medical records were reviewed for pertinent data, complications, outcome, and survival time. RESULTS: 95 dogs with congenital intrahepatic portosystemic shunts received 111 procedures (83% [79/95] had 1 treatment, and 17% [16/95] had > 1 treatment; 5 dogs had no treatment because of excessive portal venous pressure-central venous pressure gradients). Angiography identified 38 right, 33 left, and 19 central divisional single shunts (n = 90) and 10 complex or multiple shunts. Partial shunt attenuation was performed in 92 dogs by means of caval stent placement and insertion of thrombogenic coils within the shunt, and 3 had complete acute shunt occlusion. Major intraoperative complications (3/111 [3%]) included temporary severe portal hypertension in 2 dogs and gastrointestinal hemorrhage in 1 dog. Major postoperative (< 1 week after surgery) complications (14/111 [13%]) included seizures or hepatoencephalopathy (7/111 [6%]), cardiac arrest (2/111 [2%]), jugular site bleeding (2/111 [2%]), pneumonia (1/111 [1%]), suspected portal hypertension (1/111 [1%]), and acute death (1/111 [1%]). Median follow-up time was 958 days (range, 0 to 3,411 days). Median survival time for treated dogs was 2,204 days (range, 0 to 3,411 days). Outcome was considered excellent (57/86 [66%]) or fair (13/86 [15%]) in 70 of 86 (81%) treated dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that endovascular treatment of intrahepatic shunts in dogs may result in lower morbidity and mortality rates, with similar success rates, compared with previously reported outcomes for open surgical procedures. Gastrointestinal ulceration was a common finding among this population of dogs, and lifelong gastroprotectant medications are now recommended.

Feasibility of percutaneous catheterization and embolization of the thoracic duct in dogs.

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.

Silicone and polyurethane tunneled infusion catheters: a comparison of durability and breakage rates.

PURPOSE: To examine the overall durability and breakage rates of dual-lumen silicone catheters in comparison with power-injectable dual-lumen polyurethane catheters. MATERIALS AND METHODS: Patients who received a 10-F dual-lumen silicone catheter or 9.5-F dual-lumen polyurethane catheter between January 2002 and July 2009 were identified through a quality assurance database. Medical records were reviewed retrospectively. A total of 117 silicone and 94 polyurethane catheters were identified in 192 patients. Reasons for catheter placement and removal were recorded, as were cases of breakage and repairs. Catheter durability was compared; survival analysis was also performed. RESULTS: Breakage occurred in nine of 117 silicone catheters (8%) and none of 94 polyurethane catheters (P = .005). Most catheters were placed for malignancy (162 of 211; 77%); nonmalignant indications such as total parenteral nutrition accounted for 49 out of 211 catheters (23%). The mean silicone catheter dwell time was 99 days (11,612 total catheter-days), and the mean polyurethane catheter dwell time was 78 days (7,362 total catheter-days). There was no significant difference in overall duration of function (ie, survival) between silicone and polyurethane catheters (P = .12). The infection rates were 3.6 per 1,000 catheter-days for silicone catheters and 3.5 per 1,000 catheter-days for polyurethane catheters (P value not significant). CONCLUSIONS: There were fewer catheter fractures with the polyurethane catheter compared with the silicone catheter, although there was no difference in the total access site service interval for the two catheter types.

Drainage of collections associated with hernia mesh: is it worthwhile?

PURPOSE: Synthetic mesh has revolutionized abdominal wall hernia repair. However, mesh infections present a clinical problem because the standard practice of surgical excision is fraught with increased morbidity. Here, single-institutional outcomes in managing mesh-related collections via percutaneous drainage are retrospectively reviewed to assess its effectiveness. MATERIALS AND METHODS: A total of 21 patients underwent drainage of perimesh collections. Three types of mesh were employed: polytetrafluoroethylene (PTFE; n = 5), polypropylene (n = 14), and porcine dermal collagen (n = 3). One patient received both polypropylene and PTFE. Drainage was performed with ultrasound guidance (n = 19) or surgical drain exchange (n = 2). Mesh type, culture results, fluid collection size, and location were analyzed with respect to need for mesh excision. RESULTS: Sixteen of 21 patients (76%) were successfully treated with drainage. One required additional surgical capsulectomy; the mesh was salvaged. Four required mesh excision because of recurrent infection (n = 2) or lack of improvement of clinical course (n = 2). Recurrent infection occurred in six patients, with mesh salvage via conservative management or new drainage in four. Fluid cultures were positive in 68% of patients (n = 13), with Staphylococcus aureus the most common organism. Cultures did not predict mesh excision (P = .26). The PTFE excision rate trended higher compared with polypropylene (40% vs 14%; P = .27). No porcine dermal collagen mesh was excised. Neither fluid collection size nor location predicted mesh excision. Mean follow-up was 319 days (range, 6-1,406 d). CONCLUSIONS: Percutaneous drainage of suspected mesh-related abscess is effective. The use of PTFE mesh trended toward a higher excision rate.

Short-term infection in cuffed versus noncuffed small bore central catheters: a randomized trial.

PURPOSE: To determine if a polyester cuff offered benefit in jugular small-bore central catheters (SBCCs). MATERIALS AND METHODS: Eighty-four patients were randomly assigned to receive a 5-F single- or 6-F dual-lumen SBCC with (n = 42) or without (n = 42) a polyester cuff. Follow-up was performed at 2 weeks, 1 month, and 3 months or at catheter removal, whichever came first. At scheduled follow-up, catheter function, patient satisfaction, and infection were determined. At catheter removal, tip culture was performed to determine colonization and jugular vein patency was determined with ultrasonography (US). RESULTS: The overall infection rate was 0.4 per 1,000 catheter days. There was one clinical infection (noncuffed catheter). Colonization occurred in two noncuffed catheters and one cuffed catheter. There was one catheter dislodgment in the noncuffed group and none in the cuffed group. Cuffed catheters were no more difficult to insert but took slightly longer to remove (6 minutes +/- 4.7 vs 5 minutes +/- 3, P = .39) and often required local anesthesia for removal, whereas noncuffed catheters did not (41% vs 0%, P = .001). Partial (two cuffed, 0 noncuffed) or complete (two cuffed, one noncuffed) jugular thrombosis was seen on five of 58 completion US studies (8.6%). CONCLUSIONS: A polyester cuff on a SBCC confers no significant benefit in short-term colonization rates. Infection in SBCCs is uncommon. Despite their small diameters, SBCCs can result in jugular thrombosis, an important consideration in any patient requiring long-term venous access.

The case for primary placement of tunneled hemodialysis catheters in acute kidney injury.

PURPOSE: Nontunneled hemodialysis catheters (NTDCs) are widely used for initial hemodialysis access in new-onset renal failure. The National Kidney Foundation recommends NTDC use for hemodialysis duration of less than 1 week in acute kidney injury because of the increased infection risk compared with tunneled hemodialysis catheters (TDCs) with longer use. The present study was performed to determine whether primary placement of TDCs in this setting is more appropriate, and whether there are predictors of recovery of renal function in less than 1 week. MATERIALS AND METHODS: In the authors' practice, patients referred to the interventional radiology unit in whom no contraindications exist receive a TDC; 76 patients who received a primary TDC for acute kidney injury and who eventually recovered renal function were retrospectively reviewed herein. Causes of renal failure, various renal function parameters, and demographics were collected, as were TDC dwell times, in an effort to determine predictors of recovery and/or extended duration of use. RESULTS: Mean TDC dwell time in patients who eventually recovered from acute kidney injury was 34 days; only 15 of 76 (20%) recovered within 1 week. At TDC placement, there were no significant differences between patients who recovered in less than (vs greater than) 1 week. CONCLUSIONS: The present results support primary placement of TDCs in patients with acute kidney injury who require hemodialysis and in whom no contraindications exist, as no predictors of recovery of renal function in less than 1 week were identified.

Use of endovascular stents in three dogs with Budd-Chiari syndrome.

CASE DESCRIPTION: 3 dogs were examined because of Budd-Chiari syndrome (BCS), which is an obstruction of venous blood flow located between the liver and the junction of the caudal vena cava and right atrium. Two dogs had confirmed neoplastic obstructions, and the other dog had a suspected neoplastic obstruction of the hepatic veins and caudal vena cava. CLINICAL FINDINGS: All dogs had similar clinical signs of weight gain, lethargy, and ascites that did not respond to medical treatments, and 2 dogs had pitting edema of the hind limbs. Ultrasonography revealed a presumptive venous obstruction, which was confirmed by use of computed tomography. TREATMENT AND OUTCOME: Each dog was anesthetized. By use of fluoroscopic guidance, endovascular stents were placed within the left hepatic vein and caudal vena cava in 2 dogs, and a single stent was placed within the left hepatic vein extending into the caudal vena cava of the third dog. After stent placement, venous pressure in the left hepatic vein decreased. Resolution of clinical signs was dramatic in all 3 dogs (survival time ranged from 7 to 20 months), with only mild complications in 1 dog. CLINICAL RELEVANCE: Endovascular stents may be an appropriate palliative treatment for dogs with clinical signs attributable to BCS.

Preoperative mapping venography in patients who require hemodialysis access: imaging findings and contribution to management.

PURPOSE: To analyze the use of preoperative venographic mapping in patients who require permanent hemodialysis access. MATERIALS AND METHODS: Ninety-one patients underwent 108 preoperative studies. Sixty-eight (75%) were documented to have ongoing or previous hemodialysis at the time of the study. A total of 154 arms were assessed with venograms (75 right, 79 left); 74 of the patients (81%) had previous access. Venographic mapping was not performed in patients with clearly usable veins as determined by the referring surgeon. RESULTS: A total of 170 veins were suitable for access creation (ie, continuous vein of suitable caliber). Of these, 78 were used (40 fistulas [51%] and 38 grafts [49%]), and 87% of accesses were successfully used for dialysis (73% primarily, 14% after additional intervention). Anatomic variants included early brachial-basilic confluence (44%), double terminal cephalic arch (4%), and brachial-basilic "ladders" (7%). Significant central venous stenosis was found in 10% of studies, limiting the ability to use the affected side for access. There were significant associations between (i) the number of previous accesses and access type created (P = .002, Fisher exact test) and (ii) the number of veins visualized and access type created (P < .001, Fisher exact test). A greater number of previous access attempts correlated with graft rather than fistula placement for permanent access, and increased numbers of veins seen on venography correlated with an increased chance of permanent access placement. CONCLUSIONS: Venography may identify clinically occult veins usable for hemodialysis access. Anatomic variants are common and may affect choice of access site.

Percutaneous endovascular retrieval of an intravascular foreign body in five dogs, a goat, and a horse.

CASE DESCRIPTION-5 Dogs, 1 goat, and 1 horse underwent percutaneous endovascular retrieval of intravascular foreign bodies between 2002 and 2007. CLINICAL FINDINGS-Foreign bodies were IV catheters in 4 dogs, the horse, and the goat and a piece of a balloon valvuloplasty catheter in 1 dog. Location of the foreign bodies included the main pulmonary artery (1 dog), a branch of a pulmonary artery (4 dogs), the right ventricle (the goat), and a jugular vein (the horse). TREATMENT AND OUTCOME-The procedure of percutaneous endovascular retrieval of the foreign body was easy to perform in all instances. One dog was euthanized 41 days after retrieval because of worsening of another disease process, and 1 dog had abnormal neurologic signs secondary to a brain mass. All other animals were clinically normal during the follow-up period (follow-up duration, 3 to 57 months). None of the animals developed long-term complications secondary to the foreign body retrieval procedure. CLINICAL RELEVANCE-Intravascular foreign bodies that result from catheters or devices used during minimally invasive techniques are rare but may cause substantial morbidity. Percutaneous endovascular retrieval of intravascular foreign bodies was easily and safely performed in the 7 animals reported here. Use of percutaneous endovascular retrieval techniques should be considered for treatment of animals with intravascular foreign bodies because morbidity can be substantially decreased; however, proper selection of patients for the procedure is necessary.

Large or small bore, push or pull: a comparison of three classes of percutaneous fluoroscopic gastrostomy catheters.

PURPOSE: To compare the tube performance and complication rates of small-bore, large-bore push-type, and large-bore pull-type gastrostomy catheters. MATERIALS AND METHODS: A total of 160 patients (74 men, 86 women; mean age, 66.9 years, range, 22-95 y) underwent percutaneous fluoroscopic gastrostomy placement between January 2004 and March 2006. Choice of catheter was based on the preference of the attending radiologist. Data were collected retrospectively with institutional review board approval. Radiology reports provided information on the catheter, indication for gastrostomy, technical success, and immediate outcome. Chart review provided data on medical history, postprocedural complications, progress to feeding goal, and clinical outcomes. Statistical analysis was performed to compare the three classes of gastrostomy catheters. RESULTS: All 160 catheters were placed successfully. Patients who received small-bore catheters (14 F; n = 88) had significantly more tube complications (17% vs 5.6%) and were less likely to meet their feeding goal (P = .035) compared with patients with large-bore catheters (20 F; n = 72). No difference was observed in terms of major or minor complications. Large-bore push-type (n = 14) and pull-type catheters (n = 58) were similar in terms of complication rates. Patients who received large-bore push-type catheters achieved their feeding goals in significantly less time than those with large-bore pull-type catheters (average, 3.8 days vs 6.0 days; P = .04). CONCLUSIONS: Patients who received small-bore gastrostomy catheters are significantly more prone to tube dysfunction. Large-bore catheters should be preferentially used, with push-type catheters performing better with regard to the time to achieve feeding goal.

Tunneled infusion catheter breakage: frequency and repair kit outcomes.

PURPOSE: To determine the frequency of tunneled infusion catheter breakage and the durability of a repair kit used to repair damage to the external catheter segment, avoiding catheter replacement. MATERIALS AND METHODS: With use of a quality assurance database, 724 silicone tunneled infusion catheters placed between July 2002 and September 2005 were identified. The repair kit outcomes portion of the study focused on 10-F triple-lumen catheters (n = 433), the type placed most frequently in our practice and that with the most repairs available for analysis. To compare durability, nonrepaired catheters and those requiring repair were compared by using Cox proportion hazard regression. RESULTS: Breakage occurred in 53 of 443 (12%) 10-F triple-lumen catheters, three of 64 (5%) 10-F dual-lumen catheters, four of 159 (3%) 11-F triple-lumen catheters, four of 12 (33%) 9.6-F single-lumen catheters, and eight of 56 (14%) 9-F double-lumen catheters. In the 10-F subset, the mean time to catheter breakage was 60 days. The mean catheter days for the nonrepaired group (143 days) and the repaired group (145 days) were not significantly different (chi2, 0.071; hazard ratio, 1.07; P = .79). Mean catheter dwell after repair was 79 days. The failure rate for the repair kit was 14% (seven of 51 attempts). CONCLUSIONS: Tunneled infusion catheter breakage is common. Given the high breakage rates observed for many catheter designs, the development of more durable catheters should be a priority for catheter manufacturers. Until more durable catheters are developed, the catheter repair kit studied is an easy, effective, durable, and relatively inexpensive solution for the repair of external segment damage in tunneled infusion catheters.

Comparison of physician-rated performance characteristics of hydrophilic-coated guide wires.

PURPOSE: The present study was undertaken to determine whether hydrophilic-coated guide wires differed significantly according to physician-rated performance. MATERIALS AND METHODS: In this single-blinded, randomized prospective trial, three standard-shaft, 3-cm, angled-tip hydrophilic-coated guide wires were compared: the ZIPwire, HiWire, and Glidewire. Physicians rated performance characteristics on a five-point scale. RESULTS: The Glidewire had significantly greater physician-rated tip radiopacity (3.3 +/- 0.5 vs. 3.0 +/- 0.6; P = .04), wire radiopacity (3.3 +/- 0.5 vs. 3.0 +/- 0.6; P = .04), and "lubricity" (3.3 +/- 0.6 vs. 2.6 +/- 1.0; P < .01) compared with the ZIPwire. The HiWire and Glidewire did not differ significantly in any of these characteristics. Compared with the ZIPwire (2.4 +/- 1.2), the HiWire (3.0 +/- 0.7; P = .02) and Glidewire (3.2 +/- 0.6; P < .01) had significantly higher-rated lubricity retention. There were no differences in torque response, ability to navigate tortuous vessels, or tip shape retention among the three devices. The Glidewire received a significantly higher rating for overall balance of properties (3.3 +/- 0.6) compared with the HiWire (3.0 +/- 0.7; P = .01) and ZIPwire (2.7 +/- 0.8; P < .01). Overall, operators stated that the Glidewire met their expectations in 95.0% of cases compared with 75.0% for the HiWire (P < .01) and 62.5% for the ZIPwire (P < .01). CONCLUSIONS: In addition to the highest-rated overall balance of properties, the Glidewire had significantly higher-rated lubricity and radiopacity characteristics compared with the ZIPwire.

Intraluminal tracheal stenting for treatment of tracheal narrowing in three cats.

OBJECTIVE: To describe the use of intraluminal tracheal stenting in 3 cats with either benign or malignant tracheal obstruction. STUDY DESIGN: Retrospective clinical study. ANIMALS: Three client-owned cats. METHODS: Medical records were reviewed and information regarding signalment, clinical signs, physical examination findings, diagnostic tests performed, treatment, outcome and follow-up were retrieved. Intraluminal tracheal stent placement was performed as previously described in the literature. RESULTS: Three cats received intraluminal tracheal stents for the treatment of tracheal obstruction due to 3 different underlying causes: stricture secondary to traumatic endotracheal intubation, stricture secondary to a previous tracheotomy, and neoplasia. Self-expanding metallic stents of varying sizes were placed, and all cats recovered uneventfully from the procedures. The cat with tracheal neoplasia was euthanized because of pulmonary metastatic disease 6 weeks post-stent placement. The two cats with tracheal obstructions secondary to benign strictures are currently 39 months and 32 weeks post-stent placement, respectively. No complications were noted during the post-stent period in any of the 3 cats. CONCLUSIONS: Intraluminal tracheal stenting was easily, safely, and rapidly performed without complications and resulted in immediate improvement in clinical signs in all three cases. None of the cats in this study developed significant stent-associated complications during the study period. CLINICAL RELEVANCE: Intraluminal tracheal stenting has the potential to be a viable option for the treatment of tracheal obstruction in cats and perhaps for similar disease processes in other veterinary patients.

Wall-embedded recovery inferior vena cava filters: imaging features and technique for removal.

Retrievable inferior vena cava (IVC) filters may be removed when no longer needed or left in place as permanent filters. Removal of any of the currently available optionally retrieved IVC filters becomes more difficult when they are tilted. Tilting of an IVC filter can also lead the tip of the filter to become embedded into the wall of the IVC. This report describes a method for removal of the Recovery IVC filter with use of rigid bronchoscopy forceps when the tip of the filter is tilted and embedded in the IVC.

Palliative use of a stent for colonic obstruction caused by adenocarcinoma in two cats.

CASE DESCRIPTION-Two adult male castrated cats were evaluated because of a history of constipation, tenesmus, or intermittent vomiting. CLINICAL FINDINGS-Radiography and ultrasonography revealed luminal narrowing in the colon of 1 cat and a colonic mass in the other. A histopathologic diagnosis of colonic adenocarcinoma was made in both cats. TREATMENT AND OUTCOME-Under fluoroscopic guidance, a self-expanding metallic stent was advanced over a wire and across the area of colonic stenosis and deployed. One cat had progressive weight loss but maintained a normal appetite, energy, and a high quality of life. Fecal continence was maintained, and tenesmus was rarely observed. The cat was euthanized because of tumor metastasis 274 days after the colonic stent was placed. The other cat retained fecal continence, and the owners reported subjective improvement in the severity of tenesmus, compared with that prior to stent placement. The cat was euthanized 19 days after stent placement because of perceived decreased quality of life. CLINICAL RELEVANCE-The use of self-expanding metallic stents for alleviation of colonic obstruction secondary to adenocarcinoma in cats appears to be effective. This technique provides a simple, quick, nonsurgical option for palliation in cats with advanced metastatic or systemic disease in which surgical resection may not be possible or warranted.