Veterinary Image-Guided Interventions E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1854

Veröffentlichungsjahr: 2015

Beschreibung

Veterinary Image-Guided Interventions is the only book dedicated to interventions guided by imaging technology. Written and edited by leading experts in the field, interventional endoscopy, cardiology, oncology and radiology are covered in detail. Chapters include the history and background of the procedures, patient work-up, equipment lists, detailed procedural instructions, potential complications, patient follow-up protocols, and expected outcomes. Split into body systems, the technical aspects of each procedure are presented using highly illustrated step-by-step guides. Veterinary Image-Guided Interventions is a must-have handbook for internists, surgeons, cardiologists, radiologists, oncologists and criticalists, and for anyone interested in cutting-edge developments in veterinary medicine. Key features include: * A highly practical step-by-step guide to image-guided procedures * Relevant to a wide range of veterinary specialists. * Written and edited by respected pioneers in veterinary image-guided procedures * A companion website offers videos of many procedures to enhance the text

Leseprobe

CONTENTS

Cover

Title page

Copyright page

List of Contributors

Acknowledgments

About the Companion Website

SECTION ONE: Introduction

CHAPTER ONE: Tools of the Trade – Interventional Radiology

Digital Fluoroscopy and Digital Subtraction Angiography

Access Needles

Guide Wires

Introducer Sheath

Angiographic Catheters

Balloon Catheters

Drainage Catheters

Stents

Coils

Amplatz Canine Duct Occluder

Summary

Suggested Reading

CHAPTER TWO: Tools of the Trade – Interventional Endoscopy

Introduction

Equipment

Stents

Snares/Baskets/Needles

Balloons

Miscellaneous Devices

Special Recommendations

CHAPTER THREE: Oncology for the Interventionalist

Introduction

Tumor Staging

Chemotherapy

Radiation Therapy

Tumor Response Assessment Criteria

References

Supplementary Reading

SECTION TWO: Respiratory System

CHAPTER FOUR: Epistaxis Embolization

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER FIVE: Nasal/Sinus Tumors

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Intravascular Therapies

Ablation Therapies

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER SIX: Interventional Treatment Of Nasopharyngeal Stenosis

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Postprocedural and Follow-Up Care

Prognosis

Special Considerations

Suggested Reading

CHAPTER SEVEN: Intraluminal Tracheal Stenting

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Tracheoscopy

Fluoroscopic Procedure

Follow-Up

Special Considerations/Complication Examples

Tracheal Tumors and Strictures

Suggested Reading

CHAPTER EIGHT: Bronchial Collapse and Stenting

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Follow-Up

Special Considerations/Complication Examples

Suggested Reading

CHAPTER NINE: Pleural Space Disease – Thoracic Drainage and Port Placement

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Temporary Pleural Drainage Procedure

Permanent Pleural Drainage Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER TEN: Interventional Treatment of Large Airway Obstructions: Ablations, Balloon Dilation, and Foreign Body Retrieval

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedures

Postprocedural and Follow-Up Care

Prognosis

Suggested Reading

SECTION THREE: Gastrointestinal System

CHAPTER ELEVEN: Oral Tumors

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER TWELVE: Esophageal Foreign Body Retrieval

Background/Indications

Potential Risks/Complications/Expected Outcomes

Equipment

Patient Preparation

Procedure

Post-Procedural and Follow-Up Care

Prognosis

References

Suggested Reading

CHAPTER THIRTEEN: Esophageal Obstruction: Strictures/Tumors – Balloon, Bougie, Injections, Stent

Background/Indications

Potential Risks/Complications/Expected Outcomes

Equipment (Figure 13.2, Table 13.1)

Patient Preparation

Procedure

Post-Procedural and Follow-Up Care

Prognosis

Special Considerations

References

Suggested Reading

CHAPTER FOURTEEN: Gastrointestinal System: Gastric Foreign Body Retrieval

Background

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Post-Procedural and Follow-Up Care

Prognosis

References

Suggested Reading

CHAPTER FIFTEEN: Gastrointestinal Polypectomy

Background/Indications

Potential Risks/Complications/Expected Outcomes

Equipment

Patient Preparation

Procedure

Post-Procedural and Follow-Up Care

Prognosis

References

Suggested Reading

CHAPTER SIXTEEN: PEG Tube Placement

Background/Indications

Potential Risks/Complications/Expected Outcomes

Equipment

Patient Preparation

Procedure

Post-Procedural and Follow-Up Care

Prognosis

References

Suggested Reading

CHAPTER SEVENTEEN: Stenting for Gastrointestinal Obstructions

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Post-Procedural and Follow-Up Care

Prognosis

Special Considerations

Suggested Reading

CHAPTER EIGHTEEN: Image-Guided Nutritional Support Techniques

Background/Indications

Indications for Gastrostomy Tube Placement

Indications for PostPyloric Feeding

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedures

Follow-Up

References

SECTION FOUR: Hepatobiliary System

CHAPTER NINETEEN: Hepatobiliary Imaging

Imaging Protocols

Parenchymal Imaging

CT Angiography

MR Angiography

CT versus MR angiography

Outcome Measures

Hepatic Anatomy

Imaging of Hepatic Disorders

Suggested Reading

CHAPTER TWENTY: Vascular Anatomy

Introduction

Arterial System

Portal Venous System

Suggested Reading

CHAPTER TWENTY-ONE: Portosystemic Shunt Embolization: IHPSS/EHPSS

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER TWENTY-TWO: Hepatic Arteriovenous Malformations (AVMs) and Fistulas

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER TWENTY-THREE: Liver Tumors/Metastases (TAE/cTACE/DEB-TACE)

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER TWENTY-FOUR: Endoscopic Retrograde Cholangiopancreatography (ERCP) and Biliary Stent Placement

Background/Indications

Potential Risks/Complications/Expected Outcomes

Anatomy

Equipment

Patient Preparation

Procedure

Postprocedural and Follow-Up Care

Prognosis

Special Considerations

Reference

Suggested Reading

CHAPTER TWENTY-FIVE: Cholecystostomy

Background/Indications

Patient Preparation

Overview/Risks/Outcomes

Equipment for Laparoscoic Cholecystostomy

Laparoscopic Procedure

Follow-Up

Catheter Removal

Suggested Reading

SECTION FIVE: Urogenital System

CHAPTER TWENTY-SIX: Imaging of the Urinary Tract

Introduction

Excretory Urography

Contraindications/Complications

Specific Advantages of CT Excretory Urography

Interpretation

Percutaneous Antegrade Pyelography

Cystography

Urethography/Vaginourethrography

Uroendoscopy

Summary

References

CHAPTER TWENTY-SEVEN: Interventional Management of Complicated Nephrolithiasis

Background/Indications

Patient Preparation

Potential Risks/Complications

Equipment

Postoperative and Follow-Up Care

Prognosis

Special Considerations

References

Suggested Reading

CHAPTER TWENTY-EIGHT: Interventional Treatment of Idiopathic Renal Hematuria

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Postprocedural and Follow-Up Care

Prognosis

Special Considerations

References

Suggested Reading

CHAPTER TWENTY-NINE: Interventional Management of Canine and Feline Benign Ureteral Obstructions

Background/Indications

Patient Preparation/Work-up

Potential Risks/Complications/Expected Outcomes

Equipment

Interventional Management of Benign Ureteral Obstructions

Postoperative and Follow-Up Care

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER THIRTY: Interventional Management of Obstructive Pyonephrosis

Background/Indications

Patient Preparation

Equipment

Procedure

Postoperative and Follow-Up Care

Prognosis

Special Considerations

Reference

Suggested Reading

CHAPTER THIRTY–ONE: Interventional Management of Canine Malignant Ureteral Obstructions

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Postoperative and Follow-Up Care

Special Considerations

Reference

Suggested Reading

CHAPTER THIRTY-TWO: Cystoscopic-Guided Laser Ablation of Ectopic Ureters

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Postprocedural and Follow-Up Care

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER THIRTY-THREE: Minimally Invasive Treatment of Bladder and Urethral Stonesin Dogs and Cats

Background/Indications

Potential Risks/Complications/Expected Outcomes

Equipment

Patient preparation

Procedure

Prognosis

Special Considerations

References

Suggested Reading

CHAPTER THIRTY-FOUR: Urethral Stenting

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER THIRTY-FIVE: Endoscopic Polypectomy and Laser Ablationfor Benign UrinaryBladder Lesions

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Postprocedural and Follow-Up Care

Special Considerations/Alternative Uses/Complications

Suggested Reading

CHAPTER THIRTY-SIX: Intra-Arterial Chemotherapy Infusion

Background/Indications

Patient Preparation

Potential risks/complications/expected outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER THIRTY–SEVEN: Ultrasound-Guided Endoscopic Laser Ablation for Transitional Cell Carcinoma in Dogs

Background/Indications

Patient Preparation

Potential Risks/Complications/Outcomes

Equipment

Procedure

Follow-Up

Special Considerations/Complication Examples

References

Suggested Reading

CHAPTER THIRTY–EIGHT: Injectable Bulking Agents for Treatment of Urinary Incontinence

Background/Indications

Patient Preparation/Work-Up

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Bulking Agents

Postoperative and Follow-up Care

References

CHAPTER THIRTY–NINE: Percutaneous Perineal Approach to the Canine Urethra

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Complication Examples

References

CHAPTER FORTY: Percutaneous Antegrade Urethral Catheterization

Background

Preparation

Outcome

Miscellaneous

Reference

Suggested Reading

CHAPTER FORTY–ONE: Percutaneous Cystostomy Tube

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Miscellaneous

References

Suggested Reading

CHAPTER FORTY–TWO: Endoscopic Laser Ablation of Vestibulovaginal Remnants (ELA-VR)

Background/Indications

Definitions

Patient preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Follow-Up

References

Suggested Reading

SECTION SIX: Vascular/Lymphatic Systems

CHAPTER FORTY-THREE: Lymphangiography

Background and Indications

Patient Preparation

Potential Risks and Complications

Equipment List

Procedures

Suggested Reading

CHAPTER FORTY-FOUR: Vascular Access

Background/Indications

Patient Preparation

Patient Positioning

Anticipated Procedure

Potential Risks/Complications

Equipment

Arterial Vascular Access Procedures

Venous Access Procedures

Follow-Up

Special Considerations/Complication Examples

References

CHAPTER FORTY-FIVE: Foreign Body Retrieval

Background and Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations

References

CHAPTER FORTY–SIX: Hemorrhage Embolization

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER FORTY–SEVEN: Thrombectomy and Thrombolysis: The Interventional Radiology Approach

Background

Suspecting and Finding the Thrombus

Venous Versus Arterial

Anticoagulation of the Thrombotic Patient

Thrombolytic Drugs

Central Venous Thrombosis

Arterial Thrombosis

Ischemia–Reperfusion Injury

Pulmonary Thromboembolism (PTE)

Preoperative and Postoperative Anticoagulant/Antiplatelet Considerations

Reference

Suggested Reading

CHAPTER FORTY–EIGHT: Peripheral Arteriovenous Fistulas and Vascular Malformations

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER FORTY–NINE: Central Venous Vascular Obstruction

Background/Indications

Patient Preparation

Potential Risks/ Complications/ Expected Outcomes

Equipment

Procedure

Follow-Up

References

Suggested Reading

CHAPTER FIFTY: Cisterna Chyli and Thoracic Duct Glue Embolization

Background

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment List

Procedure

Suggested Reading

SECTION SEVEN: Cardiac System

CHAPTER FIFTY-ONE: Radiographic Cardiac Anatomy

Introduction

Equipment

Normal Thoracic Anatomy

Variations From Normal

Suggested Reading

CHAPTER FIFTY-TWO: Pericardial Disease

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Complication Examples

Suggested Reading

CHAPTER FIFTY-THREE: Cardiac Pacing

Backgroung/Indications

Preoperative Patient Preparation

Potential Risks/Complications/Expected Outcomes

Fluoroscopic Procedure

Pacemaker Programming

Follow-Up

Suggested Reading

CHAPTER FIFTY-FOUR: Arrhythmia Ablation

Introduction

Indications

Potential Risks, Complications and Follow-Up

Equipment

Mapping Procedure

Radiofrequency Catheter Ablation

Suggested Reading

CHAPTER FIFTY-FIVE: Heartworm Extraction

Background

Diagnosis and Patient Evaluation

Potential Risks/Complications/Expected Outcomes

Equipment

Imaging During the Procedure

Procedure

Follow-Up

Suggested Reading

CHAPTER FIFTY-SIX: Transcatheter Mitral Valve Therapies

Background

Classification of Mitral Regurgitation

Indirect Transcatheter Mitral Annuloplasty

Transcatheter Mitral (Edge-to-Edge) Repair

Transcatheter Mitral Valve Implantation

References

CHAPTER FIFTY-SEVEN: Cardiac Tumor Palliation

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Fluoroscopic Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER FIFTY-EIGHT: Patent Ductus Arteriosus

Background/Indication

Treatment Options

Potential Risks/Complications/Expected Outcomes

Procedure

Follow-Up

Special Considerations

References

CHAPTER FIFTY-NINE: Pulmonary Valve Stenosis

Background/Indications

Patient Preparation

Expected Outcomes

Equipment

Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Suggested Reading

CHAPTER SIXTY: Aortic Valve Stenosis

Background/Indications

Patient Selection, Echocardiography, and Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Follow-Up

Reference

Suggested Reading

CHAPTER SIXTY-ONE: Atrioventricular Valve Stenosis

Background/Indications

Patient Preparation

Potential Risks/Complications

Equipment

Procedure

Follow-Up

Suggested Reading

CHAPTER SIXTY-TWO: Cor Triatriatum

Introduction

Cor Triatriatum Dexter

Potential Risks/Complications/Expected Outcomes

Cor Triatriatum Sinister

References

Suggested Reading

CHAPTER SIXTY-THREE: Septal Defects

Background and Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

Procedure

Follow-Up/Prognosis

References

Suggested Reading

SECTION EIGHT: Musculoskeletal/Neurological Systems

CHAPTER SIXTY-FOUR: Tumor Ablations – Soft Tissue and Skeletal

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Ablation Therapies

Follow-Up

References

CHAPTER SIXTY-FIVE: Transarterial Embolization and Chemoembolization

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Equipment

TAE and TACE Procedure

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

CHAPTER SIXTY-SIX: Analgesic Nerve, Neuraxial, Articular and Soft Tissue Interventions

Background/Indications

Patient Preparation

Potential Risks/Complications/Expected Outcomes

Overview of Imaging Modalities, Instrumentation and Techniques

Image-Guided Interventions

Follow-Up

Special Considerations/Alternative Uses/Complication Examples

References

Index

End User License Agreement

List of Tables

Chapter 02

Table 2.1 Ureteral stenting equipment chart

Chapter 03

Table 3.1 Commonly used chemotherapy agents

Table 3.2 Chemotherapy flow sheet

Table 3.3 Chemotherapy flow sheet

Table 3.4 Veterinary Cooperative Oncology Group – common terminology criteria for adverse events (VCOG CTCAE 2012)

Table 3.5 Response Evaluation Criteria in Solid tumors (RECIST guidelines 1.1)

Method:

Unidimensional measurements (Sum of longest diameters/LDs)

Table 3.6 Tumor response criteria, World Health Organization (WHO) (Miller et al., 1981)

Method:

Bidimensional measurements (Sum of (Longest diameter × largest perpendicular diameter)+ Sum of LD of unidimensionally measured lesions)

Table 3.7 Outcomes with Chemotherapy and RT for most common tumors treated with IR techniques

Chapter 04

Table 4.1 Procedural and post-procedural medical management

Chapter 06

Table 6.1 Medications commonly used for NPS

Chapter 12

Table 12.1 Commonly Used Endoscopic Equipment (see Figure 12.5)

Chapter 13

Table 13.1 Equipment or medications often used in the management of esophageal strictures

Chapter 14

Table 14.1 Commonly used equipment in imaging of foreign bodies

Table 14.2 Instruments for the retrieval of foreign bodies

Chapter 18

Table 18.1 Abbreviations for image-guided nutritional support techniques

Table 18.2 Equipment commonly utilized for image-guided nutritional support techniques

Chapter 19

Table 19.1 Protocols for CT angiography

Chapter 21

Table 21.1 Pre- and post-procedural medical management

Chapter 22

Table 22.1 Pre- and postprocedural medical management

Chapter 23

Table 23.1 Procedural and post-procedural medical management

Chapter 26

Table 26.1

Chapter 29

Table 29.1 Medical management of ureteral obstructions

Table 29.2 Potential Outcomes of Various Ureteral Interventions

Table 29.3 Chart of stent sizing

Chapter 32

Table 32.1 Recommended equipment for female dogs during CLA-EU based on size

Chapter 33

Table 33.1 Minimally invasive treatment options for the removal of bladder and urethral stones

Chapter 36

Table 36.1 Procedural and post-procedural medical management

Chapter 37

Table 37.1 Commonly used medications - UGELAB

Chapter 46

Table 46.1 Procedural and post-procedural medical management

Chapter 47

Table 47.1 Commonly associated conditions with venous and arterial thrombosis in dogs

Table 47.2 Anticoagulant, antiplatelet and thrombolytic (fibrinolytic) drugs commonly used in clinical patients and the recommended doses and frequency of administration

Table 47.3 Agents used in the prevention and treatment of schema-reperfusion injury in dogs and cats

Chapter 49

Table 49.1 Instrumentation for endovascular stent placement

Chapter 51

Table 51.1 General guidelines for power injector settings during ventriculography in dogs

Chapter 53

Table 53.1 North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group generic code (NBG Code) for pacing system nomenclature

Chapter 57

Table 57.1 Pre- and post-procedural medical management

Chapter 58

Table 58.1 The recommended delivery system and vascular access sheath per selected ACDO device size

Chapter 60

Table 60.1 Summary of catheterization supplies needed for cutting balloon and high pressure balloon valvuloplasty for subaortic stenosis

Chapter 61

Table 61.1 Common oral medications for management of symptomatic tricuspid/mitral stenosis

Chapter 63

Table 63.1 Case selection, equipment, and potential approaches for transcatheter closure of septal defects in small animals

List of Illustrations

Chapter 01

Figure 1.1 Mobile C-arm fluoroscopy system (BV Pulsera, Philips Medical Systems). (A) C-arm stand and imaging system; (B) mobile view station.

Figure 1.2 Selective digital subtraction angiography of the azygos vein (Lateral view). (A) mask image showing the background structures before injection of contrast medium; (B) The live or contrast image including azygos vein and surrounding anatomic structure; (C) digital subtraction angiogram of the azygos vein with background subtracted.

Figure 1.3 Roadmapping fluoroscopy as a guidance in manipulation of selective catheterization in the right common carotid artery. 1 – brachiocephalic trunk, 2 – left common carotid artery, 3 – right subclavian artery, 4 – angiographic catheter, 5 – guide wire, 6 – right common carotid artery.

Figure 1.4 Seldinger needle (18 G) consists of an outer cannula and a pointed inner stylet.

Figure 1.5 Single-wall puncture needle (19 G) is also called a one-part needle.

Figure 1.6 Vascular access by the use of butterfly infusion set (21 G). After the butterfly needle (D) punctures and enters the vessel, the silicon connection tube (E) is cut through which a 0.018" guide wire is inserted. The needle is removed and the microwire is replaced with a 0.035" wire using the coaxial dilators of a micropuncture set. A regular introducer sheath is inserted over the 0.035" wire. The micropuncture set includes 0.018" guide wire (A), 21G percutaneous needle (B), and coaxial dilators (C).

Figure 1.7 Guide wires (0.035") from the left to right: straight Glidewire, Rosen wire, Safe-T-J wire, curved Glidewire, and curved Roadrunner hydrophilic wire.

Figure 1.8 Check-flo introducer sheath (A), peel-away sheath (B), and guide wire (C).

Figure 1.9 Angiographic catheters from the left to right: Cobra-II, Headhunter-I, Simmons-Sidewinder-I, and Pigtail catheters.

Figure 1.10 Angioplasty balloon catheter (5 Fr, 8 mm × 40 mm) before and after inflation.

Figure 1.11 Common drainage catheters: biliary drainage catheter (A), nephrostomy drainage catheter (B), and Malcot nephrostomy catheter (C).

Figure 1.12 Mac-Loc® multipurpose drainage catheter (10.2 Fr, Cook Medical) with the distal loop before (A) and after locking (B).

Figure 1.13 Metal stents from the top to bottom: balloon-expandable stent, covered self-expanding stent, and uncovered self-expanding stent.

Figure 1.14 Balloon-expandable stent before and after balloon inflation.

Figure 1.15 Universa

TM

double pigtail stent (4.7 Fr, Cook Medical).

Figure 1.16 Coils with different size and shape with synthetic fibers: (A) complex helical fibered platinum coil-18 (Boston Scientific); (B) MReye-35 coils (Cook Medical); (C) fibered platinum coil-35 (Boston Scientific).

Figure 1.17 Amplatz Canine Ductal Occluder connecting to a delivery cable.

Chapter 02

Figure 2.1 Integrated fluoroscopic and endoscopic operating room. (A) Standard set up for female cystoscopy. It is important to have visibility of the monitors during the procedure. (B) Notice the C-arm is at a 45 degree angle permitting an oblique view of the patient. (C) Notice the C-arm is at a 90 degree angle permitting a lateral view of the patient that is in dorsal recumbency. (D) Standard position of the C-arm during a surgically-assisted procedure, allowing the surgeons to stand on opposite sides of the table.

Figure 2.2 Portable ultrasonography machine used in the operating room.

Figure 2.3 Equipment needed for endoscopy. (A) A mobile tower to hold the various camera boxes and light sources with multiple monitors attached. (B) Light source box. (C) Light guide cable. (D) Camera box.

Figure 2.4 Flexible endoscopes. (A) Gastrointestinal video endoscope. (B) Flexible 8Fr fiberoptic ureteroscope. (C) Flexible bronchoscope.

Figure 2.5 Side-view duodenoscope used for biliary interventions. (A) The video endoscope is 150 cm long. (B) Note the side location of the lens and working channel. (C) The major duodenal papilla in a dog visualized with the side-view lens permitting direct visualization for cannulation.

Figure 2.6 Rigid endoscopes used for cystoscopy and rhinoscopy. (A) Various sized scopes (left to right) including a 1-mm semi-rigid male cat cystoscope, a 1.9-mm rigid female cat or small female dog cystoscope, 2.7-mm rigid female dog cystoscope, and a 4.0-mm rigid female dog cystoscope. (B) An instrument placed through the working channel of the endoscope. (C) Notice the 30-degree angle at the end of the endoscope that allows for 360-degree visibility in a lumen through rotation. Also notice the ingress and egress valves (white arrows) and the working channel (black arrow).

Figure 2.7 Lithotripsy equipment. (A) A Holmium:YAG laser machine. (B) Laser fibers available in different sizes for the intracorporeal lithotripter. (C–E) the Hol:YAG laser fiber in direct contact with a bladder stone in a dog during cystoscopy. Notice the stone breaking until it is cracked in half (E) and the green laser beam. (F) Dry extracorporeal shockwave lithotripsy (ESWL) machine. (G) The water bag placed onto the skin of a dog during ESWL of a nephrolith. (H) Intracorporeal lithotripsy during percutaneous nephrolithotomy in a dog. Notice the ultrasonic probe through the working channel of the nephroscope.

Figure 2.8 Electrocautery unit with various accessories. (A) The electrocautery device attached to a red and blue/yellow adaptor. (B) The foot pedal needed to activate the devices. (C) A polypectomy snare device that is then attached (D) to the red adaptor that connects to the electrocautery unit. (E) The adaptor for the Bugbee cautery probe (F).

Figure 2.9 Deployment of a balloon expandable metallic stent (BEMS). Images B, D, and F are fluoroscopic images in a cat with nasopharyngeal stenosis during stent placement. The nares are to the left of these images. (A) Percutaneous transluminal angioplasty balloon (PTA) with a metallic stent compressed on top of the balloon. Two radiopaque marks (white arrows) identify each end of the stent. (B) Un-deployed stent in the nasopharynx of a cat. (C,D) Inflating the balloon with 50/50 contrast and saline. (E,F) The stent is deployed after the balloon is deflated and removed.

Figure 2.10 A laser-cut self-expanding metallic stent (SEMS) during and after deployment. (A) The stent is compressed onto the delivery system and covered with a sheath. The delivery system is placed over a black guide wire. (B) The stent is opening as the sheath is withdrawn. (C) The stent is fully deployed. (D) The deployed stent within the urethra of a dog with obstructive transitional cell carcinoma.

Figure 2.11 Various types of mesh self-expanding metallic stents (SEMS). (A) Tracheal stent with soft rounded edges. (B) Mesh stent with sharp edges. (C) A fully covered retrievable esophageal stent. Notice the flared ends to help to prevent migration. (D) A partially covered stent. The partial covered incorporates into the mucosa to prevent migration.

Figure 2.12 Fluoroscopic images of a mesh SEMS showing the length of the stent before and after deployment to demonstrate foreshortening. Fluoroscopic images are of a dog in lateral recumbency with tracheal collapse during stent placement. The head is to the left in each image. There is a marker catheter in the esophagus. (A) The stent is on the delivery system and measures to be over 115 mm long. (B) The stent is visualized mid-deployment and now the stent is measuring about 110 mm long. (C) Once the stent is deployed it is measuring approximately 95 cm long.

Figure 2.13 Bioabsorbable esophageal stent. This is a self-expanding stent. Notice the flared ends to prevent migration.

Figure 2.14 Double pigtail ureteral stents. (A) Feline 2.5 Fr ureteral stent with tapered dilation catheter (0.034”). Notice the loops on each end of the stent to prevent migration. The stent is multi-fenestrated (red arrows) for better drainage. The distal end of the shaft has a black mark that is used to mark the end of the stent during endoscopic placement. (B) Ureteral stent used in cases with trigonal neoplasia. The distal shaft of the stent does not have any fenestrations to prevent tumor ingrowth. (C) Lateral radiograph of a cat after ureteral stent placement. Notice the proximal loop is within the renal pelvis and the distal loop is in the urinary bladder. (D) Endoscopic image of a dog with a ureteral stent in the urinary bladder. Notice the endoscopic marks (white arrow) on the stent as it exits the ureterovesicular junction.

Figure 2.15 Various types of biliary stents. (A) Polyurethane biliary and pancreatic stent that come in different sizes. The flanges help to prevent stent migration. (B) Endoscopic image of a dog with a biliary stent exiting the common bile duct (CBD) at the major duodenal papilla (MDP). (C) Fluoroscopic image of the stent within the CBD approaching the level of the gall bladder. (D) Biliary SEMS that is partially covered. These are most commonly used for common bile duct strictures or tumors. (E) SEMS as it exits the CBD at the MDP and bile coming out of the stent. (F) Fluoroscopic image of the SEMS within the CBD.

Figure 2.16 Various accessories that can be used through the working channel of an endoscope. (A and B) various types of biopsy instruments. (C) Endoscopic polypectomy snare. (D) Endoscopic basket. (E) Guide wire used for gastrointestinal and/or biliary access. (F) Sphinctertome used for common bile duct access through a side view duodenoscope.

Figure 2.17 Various types of injection needles. (A) Endoscopic injection needle. (B) Needle from (A) being placed through the endoscope working channel into the lumen of the colon. (C) Needle inserted under the mucosal tissue to inject saline prior to polyp resection. (D) Bulking agent injection needles. Marks provide reference of depth during endoscopic transurethral injection. (E) Needle through working channel of the endoscope prior to penetration into the urethral tissue. (F) Needle after penetration into the urethral tissue during bulking-agent injection. (G) Non-coring Huber needle attached to a T-port. (H) Insertion of the Huber needle into an access port during a subcutaneous ureteral bypass (SUB) placement in a cat. (I) Fluoroscopic image taken during injection of contrast through the Huber needle and SUB device.

Figure 2.18 Balloon dilation catheter equipment. (A) Insufflation device for balloon dilation catheter. (B) Balloon dilation catheter with two ports on the end. One for guide wire access and the other for balloon inflation/deflation. (C) Inflating a balloon inside a patient. (D) Fluoroscopic image of the balloon inflating an esophageal stricture. The balloon is inflated with a 50% contrast solution.

Figure 2.19 Subcutaneous ureteral bypass device (SUB). (A) Lateral radiograph of the SUB device inside a cat that was obstructed with numerous ureteroliths. Notice the three pieces: Nephrostomy tube, shunting port and cystostomy tube. (B) The same device showing all of its parts.

Chapter 04

Figure 4.1 Sample surgical cut-down set. (A) Sharp-sharps and small Metzenbaum scissors. (B) Right-angled forceps. (C) Brown–Adson and Debakey forceps. (D) Mosquito hemostats. (E) Needle drivers. (F) Kelly hemostats. (G) Small Gelpi retractors. (H) Small Babcock towel clamps. (I) Castroviejo needle drivers for vessel repair.

Figure 4.2 Equipment for standard neuroembolization (epistaxis) procedure. (A) 18-gauge over-the-needle catheter. (B) 0.035” guide wire with gentle bend manual performed on shapeable tip. The bend permits operator to turn the wire during introduction if it does not pass easily. A straight wire will not change course. (C) 5Fr vascular introducer sheath made up of shaft (white arrows) with 5Fr inner diameter, hemostasis valve (white block arrow) to prevent bleeding, and three-way stop-cock (black block arrow) to flush and/or aspirate. (D) 5Fr Dilator with 5Fr outer diameter shaft (black arrows). (E) Combination 5Fr vascular introducer sheath (white arrows) and dilator (black arrows) making smooth transition down to the 0.035” guide wire. (F) 0.035” angled, hydrophilic guide wire. (G) Standard 0.035” Teflon guide wire. (H) 4Fr Berenstein (hockey stick) angiographic catheter. (I–K) Flo-switch (I) and Touhy-Borst adapter (J) which connect (K) to form a hemostasis valve (dotted black line) and side-port that can be switched on or off (white arrow) for flushing or aspirating. This device is attached to the hub of the 4Fr catheter (at white block arrow) and allows coaxial passage of a microcatheter/microwire through the 4Fr catheter. (L) Poly-vinyl alcohol particles (or PVA hydrogel microspheres can be used instead).

Figure 4.3 Ventrodorsal angiogram (A) and digital subtraction angiogram (B) of a dog with intractable epistaxis during embolization procedure. A 4Fr Berenstein catheter (black arrows) placed via the femoral artery has been positioned in the brachiocephalic trunk (BT). The subsequent angiograms demonstrate the right subclavian (RSa), axillary (Axa), and right (RCCa) and left (LCCa) common carotid arteries. The internal thoracic artery (ITa) is apparent on the DSA study (B).

Figure 4.4 Ventrodorsal arteriogram (A), digital subtraction arteriogram (B), and digital subtraction venogram (C) of the head of a dog with intractable epistaxis. In the arteriograms (A/B), the tip of the catheter (black arrows) can be seen within the left external carotid artery (LECa). Also visible are the left maxillary (LMa) and left infraorbital (LIa) arteries. In the DSA study (B), the area supplied by the vessels to be embolized is surrounded by a white dotted line. C. This image shows the venous phase demonstrating the bilateral venous drainage (black arrows) of an angiogram performed unilaterally in the head.

Figure 4.5 Serial fluoroscopic images of a dog with right-sided intractable epistaxis. (A/B) Right common carotid arteriogram (A) and DSA (B) with the tip of the 4Fr catheter (black arrows) in the right common carotid artery (RCCa) and the microcatheter (white arrows) passing through the right external carotid artery (RECa) up to the right maxillary artery (RMa). The right infraorbital artery (RIa) is more evident on the DSA study. (C/D) Lateral arteriogram (C) and DSA (D) through the microcatheter (white arrows) with the tip in the maxillary artery (Ma). Arterial perfusion to the muzzle is evident through the minor palatine (mPa), major palatine (MPa), infraorbital (Ia), and the sphenopalatine (Sa) arteries. (E/F) Lateral arteriogram (E) and DSA (F) through microcatheter during embolization demonstrating progressive diminished perfusion, identification of the malar artery (Malar), and venous drainage (black arrows). (G/H) Final lateral arteriogram (G) and DSA (H) demonstrating diminished perfusion to the nasal cavity (white dotted line) after embolization has been completed.

Figure 4.6 Lateral DSA studies through microcatheter (black arrows) in maxillary artery before (A) and after (B) nasal embolization. There are areas of vascular blushing/hyperemia (white arrows) before (A) embolization that no longer enhance (B) when the embolized area (white dotted line) is no longer perfused. A coin (*) was placed over the eye to locate the globe during embolization.

Chapter 05

Figure 5.1 Muzzle of a canine patient with a nasal squamous cell carcinoma. (A) Note the depigmentation and scaling of the nostril. (B) The rostral lip margin has been partially devascularized and a section of skin has undergone necrosis.

Figure 5.2 Equipment utilized during embolization and chemoembolization procedures. (A) 18 gauge over-the-needle catheter; (B) 0.035-inch angled, hydrophilic guide wire; (C) vascular introducer sheath (white) and dilator (blue); (D) 4 French angled selective catheter (Berenstein); (E) 2.5 French microcatheter; (F) Touhy–Borst adapter; (G) Polyvinyl alcohol particles (Bead Block).

Figure 5.3 (A) Dorsoventral projection of the cranial chest and caudal cervical region. Femoral arterial access has been established in this dog who is undergoing chemoembolization of a nasal squamous cell carcinoma. A Berenstein catheter (Bc) has been passed to the level of the brachiocephalic trunk (BT) at the point of branching of the right common carotid artery (CCr), and an angiogram (subtracted) has been performed. (B) Dorsoventral projection of the cranial neck and caudal skull region. In Image B, a Berenstein catheter (Bc) has been advanced into the right common carotid artery (CCr) and a subtracted angiogram has been performed. The external carotid artery (EC) branch is continuing rostrally, and the maxillary artery (M) is branching directly off this vessel. (C) Dorsoventral projection of the cranial neck and caudal skull region. Image C is an unsubtracted image showing much of the same anatomy as Image B. In this image, the Berenstein catheter (Bc) has been advanced from the right common carotid artery (CCr) into the external carotid artery (EC) and a guide wire (gw) has been used to select the maxillary artery (M). (D) Lateral projection of the head. After selection of the maxillary artery with the Berenstein catheter, the patient is positioned in lateral recumbency. Image D shows the position of the Berenestein catheter (Bc) extending from the right common carotid artery (CCr) into the maxillary artery (M). An angiogram has been performed through the Berenstein catheter and the branches of the maxillary artery can be seen: infraorbital (IA) and the common trunk (ct) of the major palatine (MP) and the sphenopalatine (SP). (E) Lateral projection of the head. Image E is an unsubtracted image demonstrating the position of the Berenstein catheter (Bc) and the microcatheter (mc) and associated microwire (mw) that have been passed through the Berenstein catheter into the infraoribital artery (IA). (F) Lateral projection of the head. In this subtracted image, a microwire (mw) has been advanced into the sphenopalatine artery (SP) and an angiogram has been performed. The tumor blush (tb) can be clearly identified in this region, and chemoembolization can be pursued in this vessel as no non-target vessels are opacifying.

Figure 5.4 Cool-tip RF™ Ablation System, Covidien, Mansfield, MA. (A) Generator; (B) electrode.

Figure 5.5 SeedNet™ Cryoablation System, Galil Medical Inc., Arden Hills, MN. (A) Electrodes; (B) generator.

Figure 5.6 Embolization of a maxillary fibrosarcoma. Lateral nasal fluoroscopic (A) and digital subtraction angiography (B,C) images of a dog with nose to the right of the images. (A) Image demonstrates microcatheter in maxillary artery with mass (black dotted line) evident. (B) Pre-embolization digital subtraction angiogram (DSA) demonstrating tumor blush (black dotted line). (C) Post-embolization DSA demonstrating lack of perfusion to tumor compared to pre-embolization image. (D/E) Recheck examination one week later demonstrating very mild nasal planum erosion (white arrow) and lip margin ulceration (black arrows) due to distal embolization and ischemia. Both healed uneventfully without treatment.

Figure 5.7 Cryoablation of a maxillary fibrosarcoma. (A/B) Pre-operative images demonstrating a large right maxillary mass. (C) Hydro-dissection (injection of saline under the skin) is being performed to raise the skin off the tumor to reduce the risk of skin necrosis for such a superficial tumor. (D) Approximately one week later demonstrating patch of skin necrosis and then a few weeks later (E) demonstrating progressive healing of the superficial wound with tumor regression. (F) 3-D CT reconstruction of subsequent cryoablation performed in same patient with additional probes in overlapping positions.

Chapter 06

Figure 6.1 Computed tomography of a feline patient with NPS. (A) Transverse image of the patient showing the normal nasopharynx caudal to the stenosis. This area (the hamular processes of the pterygoid bones) is used to obtain measurements of the normal nasopharynx for stent sizing. (B) Transverse image of the patient at the level of the NPS. Notice the narrow opening with soft tissue opacity occluding over 90% of the nasopharynx. (C) Transverse image of the patient just rostral to the NPS. Notice this is the area of the nasopharynx just rostral to the junction of the hard and soft palate. This is a common location for NPS. (D) Sagittal image of the same patient. This image assists in measuring the length of the nasopharyngeal stenosis (NPS). Notice the hard palate (HP), soft palate (SP) and open nasopharynx (NP) caudal to the stricture (NPS). This view also shows the NPS sitting just caudal to the junction of the hard and soft palate.

Figure 6.2 Retroflex view of various types of NPS. (A–D) are images of the NPS prior to treatment; and images (E–H) are the respective cases after nasopharyngeal stent placement in each patient. (A) A dog that developed an NPS after soft palate surgery for a benign tumor. (B) Feline patient with a 6-year history of chronic lymphoplasmacytic rhinitis that developed severe inspiratory stertor at age 8. (C) Feline patient that was born with severe inspiratory stertor that would result in intermittent periods of open-mouth breathing. (D) A dog that was an obligate open-mouth breather that developed 3 days after ovariohysterectomy surgery. This is a non-patent NPS.

Figure 6.3 Endoscopic and fluoroscopic images of a cat with NPS during balloon dilation and BEMS placement. The patient is in lateral recumbency. (A) Retroflex rhinoscopic view of the NPS prior to intervention. (B) Guide wire passed from the ventral nasal meatus of the naris, through the NPS and down the nasopharynx. (C) Measuring catheter placed over the guidewire through the NPS. (D) Rhinoscopic image of the inflated balloon dilation catheter placed over the guide wire to dilate the NPS. (E) Dilation of the NPS after the balloon is withdrawn showing the tear in the nasopharyngeal mucosa. (F) Image of the NPS after a BEMS had been placed. (G) Fluoroscopic image that is simultaneously being taken during the procedure described above.

Figure 6.4 Fluoroscopic images of a cat with a patent NPS during BEMS placement. (This is the same patient as described above in Figure 6.3.) The patient is placed in lateral recumbency. The nares are to the left of the image. (A) A guidewire (white arrows) is being passed from the nares, down the ventral nasal meatus, and through the NPS into the esophagus. (B) Over the guide wire (white arrow) a catheter (red arrow) is placed through the stenosis. (C) This is a contrast nasopharyngeogram. A marker catheter (yellow arrow) is placed in the mouth, allowing measurement of the stenosis and adjustment for magnification. This measurement is typically not needed unless a CT is not available. Contrast is injected rostral to the stenosis through the catheter placed in image B and through the working channel of the endoscope. This allows fluoroscopic visibility of the NPS (yellow asterisk). (D) A balloon dilation catheter (blue arrows) is advanced over the guide wire, and crosses the NPS. The radiopaque marks are seen on each end of the balloon. (E) Inflation of the balloon catheter (blue arrow) at the NPS using a 50% mixture of contrast to visualize the stenosis breaking as seen in Figure F. (G) The BEMS (red arrows) is placed over the guide wire. Landmarks can be marked to ensure proper placement of the stent across the stenosis. In this image a hemostat (yellow arrow) is clamped to the fur at the stenosis. You can also use the exact location on the bullae. (H) BEMS (red arrow) being deployed as the balloon is inflated. (I) BEMS fully open. (J) The BEMS (red arrows) is in place after the balloon and guidewire are withdrawn.

Figure 6.5 Endoscopic images of piercing a non-patent NPS during BEMS placement. This patient is in lateral recumbency. The trocar needle is passed through an access sheath from the upper nare, and using endoscopic and fluoroscopic guidance, remains on midline and pierces the stenosis. (A) Retroflexed endoscopic image of a non-patent NPS. (B) Trocar needle as it pierces the NPS visualized from a retroflexed rhinoscopic view. (C) Guidewire passed through the trocar after the stylette is removed. (D) Balloon dilation catheter passed over the guide wire as the NPS is pre-dilated prior to stent placement. (E) NPS after the BEMS is placed. Notice the choanae positioned rostral to the stenosis.

Figure 6.6 Fluoroscopic images of piercing a non-patent NPS during BEMS placement. This is the same patient described endoscopically in Figure 6.4. The patient is in lateral recumbency with the nares to the left of the image. (A) Trocar needle (red arrow) is advanced through an access sheath in the ventral nasal meatus to the level of the rostral aspect of the stenosis. A guide wire (white arrow) is advanced through the working channel of the endoscopic during retroflex rhinoscope marking the caudal aspect of the stenosis. (B) The trocar needle (red arrow) is advanced on midline toward the endoscope, and through the stenosis. The stylette is removed and a guide wire is advanced through the trocar needle. (C) Over the guide wire a balloon dilation catheter (black arrows) is advanced across the stenosis to pre-dilate the tract prior to stent placement. (D) The balloon is inflated with contrast and the rostral and caudal ends of the stenosis are visualized (yellow arrows). (E) The balloon catheter (black arrows) effaces the NPS. (F) The BEMS (blue arrows) is advanced over the wire, through the nares and lined up to cover the entire stenosis. (G) The BEMS (blue arrow) is deployed by balloon inflation. Notice the ends deploy before the center. This helps to keep the stent in place during deployment. (H) The BEMS (blue arrows) after maximal balloon inflation. Notice the narrowing at the junction of the hard and soft palate. This is very common due to the oblong shape of the rostral nasopharynx. (I) BEMS (blue arrows) in place after the balloon is deflated.

Figure 6.7 Endoscopic and fluoroscopic images of a patient during balloon dilation of a NPS. No stent was placed in this patient. The patient is placed in lateral recumbency and in the fluoroscopic images the nares are to the left of the image. (A) Retroflex endoscopic image of the NPS in the proximal nasopharynx. (B) Guide wire passed from the nares and through the opening of the NPS. (C) Balloon inflated over the guide wire, across the NPS. (D) Open NPS after balloon dilation. Notice the choanae rostral to the NPS. There is still a slight narrowing of the NPS. (E) Fluoroscopic image of the NPS during balloon dilation prior to effacing the stenosis. (F) Same image as (E) after effacement of the NPS.

Figure 6.8 Complications seen with NPS stenting. (A and B) Retroflex endoscopic image of a cat 1 year after NPS placement. (A) Notice the deformity to the caudal end of the stent. (B) After re-balloon dilation of the stent. The deformity is corrected. (C and D) Endoscopic (C) and fluoroscopic (D) images of a cat with NPS 2 years after stent placement with fracture of the distal end of the stent and proliferative tissue ingrowth around the fragment (red arrows). (E and F) Endoscopic images of a cat with a proliferative reaction within the stent found 1.5 years after placement, likely associated with chronic infections. (E) A new BEMS (black arrows) prior to deployment placed through the proliferative tissue within the lumen of the first BEMS. (F) The nasopharynx after the new BEMS is deployed (black arrow) showing patency. This cat has not reobstructed in 2.5 more years. (G and H) Endoscopic images of a dog with a closed membrane NPS. (G) 6 weeks after a bare BEMS was placed the stricture grew through the stent aggressively. (H) A covered BEMS placed through the first bare stent.

Chapter 07

Figure 7.1 Radiographic variations of tracheal collapse syndrome. (A) Cervical chondromalacia (white arrows) with enlarged trachea. (B) Segmental tracheal narrowing (black arrow). (C) Segmental tracheal malformation with dorsal luminal narrowing (black arrows). (D) Diffuse chondromalacia with tracheal folding due to loss of integrity.

Figure 7.2 Endoscopic and gross variations of tracheal collapse/narrowing. (A) Endoscopic view of congenital tracheal stricture/stenosis. (B) Endoscopic view of tracheal malformation with lateral compression of tracheal rings. (C) Normal post mortem specimen of ventral aspect of canine trachea. (D) Gross mortem specimen of ventral aspect of canine tracheal malformation with “W”-shaped tracheal cartilages. (E) Endoscopic view of “W”-shaped cartilage in canine tracheal malformation demonstrating narrowed lumen. Note the “W” rather than “C” shaped cartilage rings.

Figure 7.3 Equipment needed for tracheal stenting procedure. 1A. Hydrophilic 0.035” angled guide wire. 1B. 5Fr Marker catheter. 1C. Radio-opaque endotracheal tube of at least 4mm internal diameter. 1D. Bronchoscope adapter. 1E. Tracheal stent on delivery system with partial stent deployment. 1F. Deployed tracheal stent (not necessary; for demonstration only). 2. Close-up view of marker catheter with guide wire (black arrow) extending 3–5 cm out the tip prior to advancement down the esophagus. Note the distance from the beginning of one mark to the beginning of the next (white arrow) is 10 mm. 3. Close-up view of the tracheal stent delivery system. Prior to use sterile saline is injected in the proximal port and side port (black arrows) to remove air and moisten stent. The diaphragm is then unlocked by twisting the dial on the Y-piece (white arrow). 4A. Close-up view of deployed tracheal stent. 4B. Partially constrained tracheal stent. Prior to placement within the patient the stent is only slightly deployed to make certain everything is working. Note the partially constrained stent and partially deployed stent (white arrow). As the stent is deployed, it retracts away from the nose cone (black arrow).

Figure 7.4 Serial lateral radiographs in a dog demonstrating variability under static versus dynamic ventilatory pressures. RESTING: Static radiograph demonstrating minimal degree of collapse. PPV: 20 cmH

2

O positive pressure ventilation demonstrating maximal tracheal diameter. NPV: –10 to –15 cmH

2

O demonstrating diffuse tracheal and carinal collapse.

Figure 7.5 Positive (PPV) and negative pressure ventilation (NPV) device. Positive pressure can be achieved with the anesthesia machine but this device is necessary to perform NPV. A dosing syringe is attached to a sphygmomanometer (black arrow) and anesthesia tubing with an adapter (white arrow) to attach to the ET tube. PPV at 20 cmH

2

O and NPV at –10 to –15 cmH

2

O are performed.

Figure 7.6 Lateral 20 cmH

2

O positive-pressure radiographs with esophageal marker catheter in place performed for determining maximal tracheal diameter and length of stent necessary. Top: Measurement from the beginning of one marker to the next is 11 mm. Maximal cervical and intrathoracic tracheal diameters are 13 mm and 10 mm, respectively, prior to accounting for radiographic magnification. Bottom: Cricoid cartilage (black arrows) identified rostral to air in the esophagus (white arrows) and the carina (white block arrow) mark the extent of the trachea. Using a 10 mm safety margin from each of these landmarks, a maximum of 85 mm of trachea will be stented. Right: Radiographic magnification is calculated and used to determine the actual maximum cervical and intrathoracic tracheal diameters of 11.8 mm and 9 mm, respectively.

Figure 7.7 Stent shortening chart for 14 mm tracheal stents (www.infinitimedical.com). For the trachea in Figure 7.4, a 14 mm diameter stent will be used in order to be 2–3 mm greater diameter than maximum measured. The chart above demonstrates the various lengths different 14 mm diameter stents will achieve when expanded to different diameters. A 14 × 58 mm stent expanding between 9 mm and 11.7 mm will ultimately expand to approximately 85 mm.

Figure 7.8 Stent deployment. The stent delivery system is held with two hands, the front hand (FH) holds the Y-piece connector of the delivery system (white arrow) and the back hand (BH) holds the hub (black arrow). During deployment, the two hands move together to meet in the middle (the dotted black line). As the FH moves back, the stent is exposed. As the BH pushes forward, the stent is advanced down the trachea. If done correctly, the leading edge of the stent is motionless as the stent is deployed. The nose cone of the delivery system will advance down the trachea and the stent will shorten from the cranial edge. During deployment, remember that the BH determines the location of the stent and the FH deploys it.

Figure 7.9 Serial images taken during stent deployment. (A) Constrained stent (white arrows) in place prior to deployment. Note the location of the nose cone (black arrow). (B) As deployment proceeds, the stent (white arrows) expands from the leading edge and the nose cone advances down the trachea (black arrow) as the stent shortens from the cranial edge. At this time gentle back and forth movement of the delivery systems confirms friction and an appropriate stent diameter. (C) Just before final deployment retract ET tube (white block arrow). (D) After deployment the ET tube (white block arrow) is advanced over the delivery system and the nose cone (black arrow) is gently retracted with the delivery system. Note the stent (white arrows) is substantially shorter than it was in the delivery system prior to deployment (A).

Figure 7.10 Various tracheal stent complications. (A) Stent placed into mainstem bronchus. Note stent tapering at level of carina (black arrow). (B) Stent placed within cricoid. Note stent tapering (black arrow) ventral to the cricopharyngeus muscle (white arrows). (C) Undersized stent with incomplete tracheal contact and mucus accumulation. (D) Stent undersizing with gap (black arrows) between stent and tracheal wall on radiographs. (E) Inflammatory tissue development at cranial aspect of stent (white arrows) resulting in luminal narrowing. (F) Tissue ingrowth at thoracic inlet (between black arrows). (G) Inflammatory/granulation tissue (asterisk) identified and biopsied during tracheoscopy. (H) Early stent fracture (black arrows) along dorsal, intrathoracic portion of the stent.

Figure 7.11 Lateral thoracic radiographs in two cats with tracheal obstructions. Left: Cat with tracheal tumor and subsequent airway obstruction prior to (above) and following (below) self-expanding, mesh metallic stent placement. Right: Cat with benign tracheal stricture prior to (above) and following (below) laser-cut, self-expanding stent placement.

Chapter 08

Figure 8.1 Chest radiograph of a patient that had a bronchial stent placed in LPB 8 months after placement of the tracheal stent.

Figure 8.2 Canine bronchial tree showing the left principal bronchus (LPB), left cranial lobar bronchus (LB1), and the left caudal lobar bronchus (LB2), right principal bronchus (RPB), right cranial lobar bronchus (RB1), right middle lobar bronchus (RB2), right caudal lobar bronchus (RB3), right accessory lobar bronchus (RB4).

Figure 8.3 Bronchoscopic image showing grade 4 collapse of LB2 and LB1.

Figure 8.4 Equipment used for bronchial stenting; (A) 0.035” j-tip guide wire. (B) 5Fr Sizing catheter. (C) Sizing balloon. (D) Red rubber catheter. (E) Ultraflex proximal release stent. (F) Partially deployed custom sized (8 × 20 mm) tracheal stent (for demonstration).

Figure 8.5 Fluoroscopic image of a Tyshak balloon distending LB2 to its normal diameter. A measuring catheter is in place in the esophagus to provide a centimeter scale to measure the balloon diameter.

Figure 8.6 Procedural steps for bronchial stenting; (A) Guide wire being advanced through LB2. (B) 5Fr Stent delivery system being passed over the guide wire into LB2. (C) Partial deployment of stent. (D) Complete deployment of stent after removal of the delivery system and guide wire. (E) Pre-procedure lateral chest radiograph. (F) Post-procedure lateral chest radiograph showing the deployed stent.

Figure 8.7 (A) Post-procedure chest radiograph documenting bronchial stent position in LB2. (B) Chest radiograph taken the day after the procedure demonstrating migration of the stent into the trachea.

Figure 8.8 (A) Chest radiograph taken three months after bronchial stent placement indicating a lobar pneumonia. (B) Bronchoscopic image from the same patient showing sample collection from the infected stent for cytology and culture.

Chapter 09

Figure 9.1 Equipment utilized to gain entrance into intrathoracic cavity. (A) 18 gauge over-the-needle catheter; (B) 0.035-inch hydrophilic guide wire; (C) peel-away sheath (1) and dilator (2).

Figure 9.2 Equipment utilized during permanent thoracic drain placement. (A) Subcutaneous port. (B) Multi-fenestrated thoracic drainage catheter. (C) Two versions of Huber needles – 1. Huber needle with attached tubing, 2. Huber needle alone. (D) Close-up images of two Huber needle points.

Figure 9.3 Locking-loop pigtail catheter and associated equipment. (A) 1. Proximal end of locking-loop pigtail catheter, 2. Clasp utilized to fasten the suture, 3. Cannula, 4. Stylet. (B) 1. The stylet has been advanced and locked into the cannula to expose the distal pointed/sharp tip, 2. Exposed suture that can be pulled to lock the pigtail loop in place when the stylet and cannula have been removed, 3. Locking-loop pigtail catheter.

Figure 9.4 (A) Locking-loop pigtail catheter with clasp unlocked. (B) When the pigtail catheter is unlocked and the cannula and stylet have been removed, the pigtail loop is still formed; however, the suture responsible for locking the loop is loose and the loop can be easily undone. (C) Locking-loop pigtail catheter with clasp locked. (D) When the pigtail catheter is locked, the suture responsible for locking the loop cannot be visualized as it is tightened. The loop is not easily undone in this position.

Figure 9.5 Placement of a locking-loop pigtail catheter for temporary drainage into the pleural space without a guide wire. A stab incision (A) can be made to facilitate entrance of the locking-loop catheter into the pleural space, or the locking-loop pigtail catheter and associated stylet and needle can be advanced directly into the pleural space (B). Once the locking-loop pigtail catheter has been introduced into the pleural space, the catheter can be passed over the stylet into the pleural space (C). When positioned correctly, a syringe can be attached to the catheter to allow for fluid or air aspiration (D).

Figure 9.6 Placement of a locking-loop pigtail catheter for temporary drainage into the pleural space with a guide wire. An 18 gauge over-the-needle catheter is introduced into the pleural space (A). When fluid is obtained, the needle is removed and a 0.035-inch hydrophilic guide wire is introduced through the catheter into the pleural space with fluoroscopic-guidance (B). The locking-loop pigtail catheter is flushed with saline, as the catheter will be passed over the hydrophilic guide wire (C). The catheter is passed over the guide wire to the body wall (D) and then eventually into the pleural space. Once the holes of the catheter have been completely introduced into the pleural space, the guide wire can be removed.

Figure 9.7 Placement of a thoracic drainage catheter and subcutaneous port for permanent pleural space drainage. The lateral thorax is clipped, prepared with aseptic technique and draped (A). The location of the port (10th intercostal space) and thoracocentesis site (8

th

–9th intercostal space) are determined (B). A hemostat is passed (C) subcutaneously from the dorsal incision to the stab incision (at the thoracocentesis site). The thoracic drainage catheter is passed between the incisions (D). After thoracocentesis, the 0.035-inch hydrophilic guide wire (gw) is passed into the pleural space through the 18 gauge over-the-needle catheter with fluoroscopic-guidance (see Figure 9.6). A peel-away sheath (ps) is placed over the guide wire into the pleural space after removal of the catheter. The thoracic drainage catheter can then be passed through the peel-away sheath. (E). When the thoracic drainage catheter has been placed sufficiently into the pleural space (fluoroscopy is utilized to determine that all holes are located intra-thoracically), the peel-away sheath can be peeled down leaving the catheter in place (F). After the fenestrated end of the thoracic drainage catheter has been placed into the pleural space, the external end is attached to the port, and the port is placed into the subcutaneous pocket (G). A Huber needle should be inserted into the port to test for the removal of fluid and air; this can be done both prior to and after closure of the port (dorsal) incision (G and H).

Figure 9.8 Ventrodorsal and lateral radiographic projections of a cat with a thoracic drainage catheter and subcutaneous port. The drainage catheter was placed to remove air in this cat who was developing pneumothorax secondary to a congenital pulmonary parenchyma abnormality.

Chapter 10

Figure 10.1 Equipment used for various large airway interventions. (A) Electrocautery unit that has both monopolar, bilpolar and blend settings. Notice the two adaptors (red for attachment to the polypectomy snare, and blue/yellow for the Bugbee cautery probe). (B) This is a snare polypectomy device. (C) The snare with the adaptor on the handpiece, which is attached to the electrocautery unit (red adaptor). (D) Once the adaptor is connected it will allow activation of the snare that is controlled by a foot pedal. (E) Adaptor for the Bugbee cautery probe. (F) Bugbee cautery probe. (G) Foreign body retrieval basket. (H) Hot-knife electrocautery probe through the working channel of the bronchoscope. It is creating defects in a tracheal stricture in a dog prior to balloon dilation. (I) Balloon dilation catheter with a soft tip to aid in dilation of tracheal strictures.

Figure 10.2 Endoscopic images of a dog with a polypoid lesion arising from the dorsal tracheal membrane occluding the tracheal lumen. (A) Thick stalk of the mass visualized. (B) Polypectomy device being used to test the power settings using the tip on the mass. (C) The snare being placed around the mass. (D) The snare entrapping the base of the polypoid mass as it is pulled cranially toward the scope to prevent electrocautery caudally. (E) Removal of the polypoid mass once it fell from the base of the stalk. (F) The resultant base of the mass after polypectomy.

Figure 10.3 Endoscopic and fluoroscopic images of a dog with a broad-based, non-resectable, granuloma of the trachea sitting at the carina. (A) Tracheoscopic image of the mass occluding 90% of the lumen. (B) Unsuccessful attempt at polypectomy/electrocautery of this mass to open the airway. (C) Fluoroscopic image during positive pressure ventilation (20 cmH

2

0) with a marker catheter in the esophagus. This allowed for measurements of the tracheal lumen for stent placement. (D) Placement of the stent within the tracheal lumen under fluoroscopic guidance. (E) Endoscope placed next to the delivery system of the stent during initial deployment because the mass extends to the carina. Care is taken not to place the stent down one of the mainstem bronchi. (F) Once the caudal aspect of the stent was determined to be in an appropriate position the endoscope was withdrawn to the cranial aspect of the stent prior to deployment. (G) The stent being deployed under fluoroscopic guidance. (H–I) The endoscope visualizing the caudal end of the stent using both endoscopic and fluoroscopic guidance. (J) Due to the caudal end of the stent remaining compressed just cranial to the carina a guide wire is placed through the lumen of the stent using both endoscopic and fluoroscopic guidance to allow a second stent to be placed to reinforce the first (K) and balloon dilate the distal end (L).

Figure 10.4 A 3-month-old dog with an intrathoracic tracheal stricture, likely secondary to trauma. Due to the small size and expected growth of the patient a stent was not used and instead the lesion was cut with an electrosurgical knife and balloon dilated. (A) Endoscopic image of the stricture in the distal intrathoracic tracheal lumen. (B–E) Cutting the strictured tissue with the electrosurgical knife (black arrows) using endoscopic guidance in three areas. (F) The tracheal lumen after balloon dilation. The carina (yellow arrow) can now be seen through the stricture .

Figure 10.5 Radiographic and fluoroscopic images of an 8-week-old Pug with a foreign body (FB) at the carina. (A) Lateral radiograph of a round object (black arrowhead) sitting at the carina. (B) V/D fluoroscopic image of the dog after a guide wire (black arrow) is placed through the endotracheal tube, down the trachea, and into the right bronchus beyond the FB. (C) A FB retrieval basket (white arrow) placed next to the wire to entrap the FB (black arrowhead). (D) Lateral radiograph of patient after FB removed .

Figure 10.6 Endoscopic images of a Labrador Retriever with a 1-week history of chronic cough. Tracheal opacity seen on radiographs. (A) Tracheal foreign body (FB) seen endoscopically. (B) FB retrieval basket used through the working channel of the endoscope to entrap the object. (C) The FB is being removed through the tracheal lumen. (D) The FB seen before it exits the larynx.

Chapter 11

Figure 11.1 Equipment utilized during embolization and chemoembolization procedures. (A) 18 gauge over-the-needle catheter. (B) 0.035-inch angled, hydrophilic guide wire. (C) Vascular introducer sheath (white) and dilator (blue). (D) 4 French angled selective catheter (Berenstein). (E) 2.5 French microcatheter. (F) Touhy–Borst adapter. (G) Polyvinyl alcohol particles (Bead Block).

Figure 11.2 Hard palate melanoma: Serial images in a dog with an extensive hard palate malignant melanoma with partial nasal cavity occlusion and dysphagia. (A/B) Preoperative images demonstrating extent of mass on oral hard palate, crossing midline, and extending laterally. (C) Cryoablation performed with CT-guidance with multiple probes demonstrating frozen tumor and probes. (D) Immediately post-cryoablation demonstrating severely hyperemic tumor. (E) One day post-cryoablation demonstrating darkening and necrosis of tumor. (F) A few weeks post-cryoablation demonstrating sloughed tumor and ulcerated hard palate with tissue necrosis and clear margin of cryoablation zone. The dog was eating and did not appear overtly sensitive to this area likely due to the diffuse necrosis.

Chapter 12

Figure 12.1 Endoscopic images of various esophageal obstructions. (A) Esophageal tumor with food proximal. (B) Esophageal polyp, (C) esophageal stricture, (D,E) radiographs of a dog with an esophageal mass showing the contrast of air outlining the lesion.

Figure 12.2 Lateral and VD radiographs of a dog with a bone esophageal foreign body.

Figure 12.3 Endoscopic images of various esophageal lesions after foreign body removal with a high risk of perforation. (A) The black, bluish mucosal color is indicative of severe mucosal injury, however this lesion is superficial. (B) Esophageal lesion that has a blue-blackish discoloration, moderate depth of injury, and the white superficial, necrotic mucosal layer. (C) Esophageal lesion with hemorrhagic discoloration and moderate-severe depth of injury. (D) Esophageal lesion that is necrotic and pale. This has a high risk of perforation. The true depth of the injury cannot be assessed in this case until the superficial necrotic layer is debrided. (E) While this lesion is not overtly discolored, the depth of injury puts this patient at great risk of perforation. Note that it is not possible to determine whether small perforation exists in this patient. Radiography and antibiotic therapy is recommended.

Figure 12.4 Endoscopic images of various esophageal lesions after foreign body removal at low risk of perforation. Note varying degrees of esophagitis with some patients having focal, multifocal or concentric diffuse changes. Additionally, patients have variable degrees of mucosal defects ranging from superficial erosions to deep ulcers. Variations in mucosal color can be observed; as dictated by the degree of mucosal compromise and duration of foreign body contact.

Figure 12.5 Various equipment used for foreign body retrieval. (A) rat tooth retrieval forceps; (B) longer rat tooth retrieval forceps; (C) 4 wire basket; (D) small non-rotating endoscopic snare; (E) large non-rotating endoscopic snare; (F) roth net; (G) 3 prong grasper; (H) multidiameter endoscopic balloon; (I) rigid rat tooth gasper; (J) laparoscopic forceps; (K) orogastric tube (“overtube”).

Figure 12.6 Radiographs of two dogs with esophageal perforations from foreign bodies resulting in pyothorax. When large effusions are present, foreign objects may be difficult to identify. These patients are at great risk of developing a pneumothorax during the retrieval procedure.

Figure 12.7 Deformed endoscopic loop, which can occur with inappropriate use. The equipment should be carefully manipulated over/around foreign material and not opened directly onto the foreign body, as it will become deformed.

Figure 12.8 Endoscopic images of three dogs during foreign body retrieval. (A) A 3-pronged grasper is directed into the foreign body for purchase; (B) an endoscopic basket is placed over the object for engagement; (C) a loop is manipulated around the edge of the foreign object. Firm purchase of a small piece of the foreign object may help with extraction.

Figure 12.9 Endoscopic images of a dog with an esophageal foreign body during basket retrieval. (A) The instrument is passed beyond the foreign body in a closed position. (B) The instrument is opened and then pulled forward to line-up around the foreign body. (C) The basket is moved back and forth encouraging the wires to engage the foreign object.

Figure 12.10 Endoscopic images of foreign body retrieval using a rigid instrument. Note that this these instruments engage the foreign objects carefully and under direct endoscopic visualization. Passage of these rigid instruments may require manipulation of the cervical region to “straighten out” the esophagus and reduce iatrogenic mucosal trauma.

Figure 12.11 Endoscopic images with various points of engagement in the esophageal wall. (A) The foreign body is fixed in place within the esophagus. It is tough to appreciate the depth of mucosal engagement that is present. (B–F) Various depths of foreign body engagement prior to endoscopic removal. These points represent areas of weakness; the endoscopist should be aware that putting excessive pressure on these areas may cause esophageal perforation.

Figure 12.12 Overtube usage. (A) Use of an overtube to help with dislodgement of a fixed esophageal foreign body. The overtube is placed around the endoscope and directed between the foreign object and the wall. This pushes the wall laterally to disengage points of fixation and protects the scope. (B) The overtube is contacting the foreign object on the side, not directly. Occasionally, the overtube can dilate the esophagus wide enough to allow for retraction of the foreign object into its lumen for removal. (C,D) A model showing the use of an overtube to retract a sharp foreign body for protection of the esophageal lumen during retraction.

Figure 12.13 Endoscopic images of patients with esophageal perforations. (A) Mediastinal defect in the esophagus and the separate defect in the mediastinum, entering the pleural space. This patient required a thoracic tube. Note the potential for insufflation causing severe respiratory compromise from pneumothorax. (B) The same patient as image A evaluated 1 month following the procedure with complete healing and a slight stricture at the perforation site. (C) A perforation that was not overtly obvious on observation; this patient had a pyothorax managed with thoracic tubes. (D) Rapid healing is observed. This image is 10 days after image C was taken.

Figure 12.14 An intraoperative radiograph demonstrating bilateral thoracic tubes placed for pneumothorax after an esophageal perforation. Note the PEG tube placed to bypass the esophageal defect esophageal.

Figure 12.15 Nasomediastinal tube placement following mediastinal penetration. These tubes can be used to evacuate air during perforation or for post-operative drainage