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Marget MJ, Gelbard A. Removal of Metal Tracheal Stent: A Difficult Foreign Body. Laryngoscope 2024; 134:3977-3980. [PMID: 38529714 DOI: 10.1002/lary.31421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION With its introduction in 1986, the use of metal tracheal stents gained favor due to relative ease of deployment and reduced risk of stent migration and mucus plugging. However, adverse events associated with metal stenting led the FDA to publish a recommendation against its use for benign airway stenosis in 2005. We present a case which illustrates the difficulty in removal of a metal stent from the airway. CASE REPORT Our patient is a 47-year-old woman with a history of postintubation tracheal stenosis. She underwent multiple interventions with Thoracic Surgery at an outside facility, including stenting with an Ultraflex expandable metal stent. Her course was complicated by recurrent intraluminal granulation tissue, which led to placement of additional metal stents, as well as a tracheostomy due to obstructive proximal granulation tissue. On presentation at our institution, removal of the stents was recommended due to recurrent tracheitis and proximity of stent fragments to the innominate artery on CT imaging. She underwent direct microlaryngoscopy and bronchoscopy, and stent fragments were removed using a hemostat through the trach stoma. Postoperative imaging has confirmed retained stent fragments, and additional procedures have been required for further removal. DISCUSSION/CONCLUSION Removal of metal stents from the trachea is challenging for several reasons. Neoepithelization of respiratory mucosa makes identification of fragments difficult. Furthermore, growth of granulation tissue through the metal lattice framework, as well as the stents' tendency to fracture, complicates extraction. This case illustrates the dangers of metal stenting for benign airway stenosis. Laryngoscope, 134:3977-3980, 2024.
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Affiliation(s)
- Matthew J Marget
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Alexander Gelbard
- Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Majid A, Ospina-Delgado D, Ayala A, Gangadharan SP, Alape D, Buitrago D, Parikh MS, Wilson JL, Chee AC, Fernandez-Bussy S, Herth FJF, Kheir F. Stent Evaluation for Expiratory Central Airway Collapse: Does the Type of Stent Really Matter? J Bronchology Interv Pulmonol 2023; 30:37-46. [PMID: 35318996 DOI: 10.1097/lbr.0000000000000842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Careful selection of patients with expiratory central airway collapse (ECAC) that may benefit from tracheobronchoplasty (TBP) can be aided by a short-term airway stent evaluation. This can be performed with either silicone Y-stents (SYSs) or uncovered self-expanding metallic airway-stents (USEMAS). No direct comparison has been made between these 2 stent types. METHODS This was a small retrospective review of consecutive patients that underwent a stent evaluation. A propensity score was used to match patients in the USEMAS and SYS groups. Outcomes included complications, changes in the health-related quality-of-life (HR-QoL), and changes in exercise capacity. Baseline measurements were compared with those obtained during stent evaluation and after TBP. RESULTS Forty-two patients with severe ECAC underwent USEMAS placement, while 18 patients had an SYS placed. Propensity score matching resulted in 13 matched SYS and USEMAS pairs. The SYS group had an increased rate of mucus plugging (38.5% vs. 0%, P <0.047). Although not statically significant, a clinical improvement was observed in HR-QoL and exercise capacity in the USEMAS group during stent placement. In patients who underwent TBP, both USEMAS and SYS groups had a statistically significant change in the Modified Medical Research Council Dyspnea Scale during stent evaluation and after TBP. CONCLUSION In patients with severe ECAC, short-term evaluation with airway stents appears to be safe and improves respiratory symptoms, HR-QoL, and exercise capacity. The use of USEMAS led to a lower complication rate, a greater improvement in HR-QoL and exercise capacity, and appeared to better predict how the patients would respond to TBP.
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Affiliation(s)
- Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Daniel Ospina-Delgado
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Alvaro Ayala
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Daniel Alape
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
- Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Daniel Buitrago
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Mihir S Parikh
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Jennifer L Wilson
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Alex C Chee
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | | | - Felix J F Herth
- Department of Pulmonary and Critical Care Medicine, Thoraxklinik-University of Heidelberg, Heidelberg, Germany
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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Guinde J, Bismuth J, Laroumagne S, Coiffard B, Astoul P, Thomas PA, Reynaud-Gaubert M, Dutau H. Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience. Respiration 2022; 101:675-682. [DOI: 10.1159/000523755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative. <b><i>Objectives:</i></b> This retrospective study sought to assess the short- and long-term outcomes of patients treated with customized bifurcated stent (CBS) for the management of AC following LT. <b><i>Methods:</i></b> Data from patients with AC following LT requiring CBS placement between June 2010 and June 2020 were analyzed. <b><i>Results:</i></b> Four hundred patients underwent lung transplant. AC requiring airway stenting occurred in 32 patients (8%), and CBS were inserted in 15 patients (3.5%). Indications were stenosis (<i>n</i> = 12; 80%) and bronchial dehiscence (<i>n</i> = 3; 20%). CBS were successfully deployed in 14 patients and failed in 1 patient. No migration was recorded during the follow-up. The median number of complication was 1 per patient (0–5). CBS could be removed in 11 patients (78.6%), and 3 died with their stents in place. AC recurrence or complications requiring new stenting occurred in 4/11 patients (36.3%), with a median time of 7 days (0–29). Seven patients (63.7%) had no AC recurrence, with a median follow-up of 925 days (118–3,249). <b><i>Conclusions:</i></b> The actual surgical anastomotic technique in LT provides new endoscopic challenges. CBS seem ideally positioned to address these difficulties safely and effectively but are associated with stent related complications requiring further endoscopic management.
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Bartlett-Pestell S, May J, Sharma A, Alonzo S, Barnes N, Madden BP. A 12-year experience in endobronchial intervention using rigid bronchoscopy - account of a tertiary referral centre. Monaldi Arch Chest Dis 2022; 92. [PMID: 35347973 DOI: 10.4081/monaldi.2022.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 11/22/2022] Open
Abstract
We describe our experience of rigid bronchoscopy and endobronchial intervention at a single tertiary centre over a 12-year period. All rigid bronchoscopy procedures between July 2008 and July 2020 (inclusive) were reviewed. All procedures were performed in cardiothoracic theatres by a designated team under general anaesthesia. 2135 rigid bronchoscopies were performed on 1301 patients aged between 18 and 93 years. Complications occurred in 24 (1.12%) procedures. There was one fatality (0.05%). Haemorrhage >100mls occurred in seven (0.33%) all of which were successfully managed endobronchially. Ten procedures (0.5%) were complicated by pneumothorax and an intercostal drain was required for eight. Five patients required intensive care admission post operatively, all of whom were subsequently discharged from hospital. One patient had stent migration. To the best of our knowledge, this is amongst the largest single centre collection of data available for endobronchial intervention using rigid bronchoscopy. We show that rigid bronchoscopy is a safe and effective procedure when performed in a high-volume specialist centre with designated lists involving a specialist multidisciplinary team.
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Affiliation(s)
- Sam Bartlett-Pestell
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - James May
- Department of Cardiothoracic Surgery, St. George's Hospital, Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Ashutosh Sharma
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Sunshine Alonzo
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Natalie Barnes
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Brendan P Madden
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
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Nachiappan M, Thota R, Gadiyaram S. Surgery Complicated by Self-Expandable Metallic Stents (SEMS) Tracheal Stent in a Congenital H-type Tracheo-Esophageal Fistula. Cureus 2022; 14:e22109. [PMID: 35308695 PMCID: PMC8923044 DOI: 10.7759/cureus.22109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/19/2022] Open
Abstract
A congenital tracheo-esophageal fistula of the H-type is a rare variant. The diagnosis is usually missed because of mild symptoms. A long history of coughing during liquid intake and nocturnal cough may aid in the diagnosis. A delay in the diagnosis may have a deleterious effect on the lung because of recurrent infections. Surgery is the cornerstone of management. Self-expandable metallic stents (SEMS) do not have a role in the management of these fistulae. We report a case of a missed diagnosis of a congenital H-type fistula managed as an acquired tracheo-esophageal fistula with two attempts at conservative management with a tracheal self-expandable metallic stent. The difficulties and disadvantages of using self-expandable metallic stents for the management of benign tracheo-esophageal fistulae are also discussed.
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Sato S, Chaki T, Onaka T, Yamakage M. Anesthetic management of tracheal stent extraction using a double gum elastic bougie technique. JA Clin Rep 2022; 8:9. [PMID: 35113248 PMCID: PMC8814201 DOI: 10.1186/s40981-022-00500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Tracheal stenosis is a life-threatening condition, and management of a patient with a risk of tracheal stenosis is challenging for anesthesiologists. In this report, we describe a method for airway management using two gum elastic bougie method when removing a tracheal stent via a tracheostomy orifice with a risk of airway restenosis. Case presentation A 71-year-old man had an enlarged squamous cell carcinoma of the lung invading the upper mediastinum that had caused severe stenosis of the trachea. Two months after diagnosis, a tracheal stent had been placed to maintain tracheal patency. One month after stent placement, acute respiratory failure was induced by upper airway obstruction caused by subglottic airway edema due to mechanical stimulation of the cranial end of the stent, and the patient was rescued by oral tracheal intubation. Tracheal stent extraction was scheduled to relieve the laryngeal edema. Since there was a risk of tracheal restenosis because of the possibility of accidental evulsion of the orally tracheal tube which intubated to secure an emergency airway and tracheal stent extraction, two gum elastic bougies were inserted through the oral tracheal tube and tracheostomy orifice to facilitate re-intubation. After extraction of the tracheal stent, airway openness was maintained and tracheostomy was completed without any complication. Conclusion Successful management of tracheal stent extraction was performed using a double gum elastic bougie technique.
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Affiliation(s)
- Satoshi Sato
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Takayuki Onaka
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Rusakov MA, Parshin VD, Simonova MS, Kozhevnikov VA, Parshin AV. [Airway stenting in patients with complex benign tracheobronchial stenosis]. Khirurgiia (Mosk) 2022:5-12. [PMID: 36398949 DOI: 10.17116/hirurgia20221115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Tracheal and bronchial stenting is actively used for cancer and benign airway stenosis. This procedure is common in patients with advanced cancer. Stenting ensures breathing and availability of early chemo- and radiotherapy without the need for tracheostomy. This procedure is less common in patients with benign tracheal stenosis. In this case, isolated tracheal or bronchial stenting is performed. Complex tracheobronchial stenosis is extremely rare and creates significant difficulties. We present 3 cases of tracheobronchial stenting for cicatricial stenosis. In each case, stenosis was dilated with a rigid bronchoscope or balloon dilatation. Then, a silicone stent was installed. Resection with an appropriate anastomosis was contraindicated due to advanced pathological process. Thus stenting was regarded as a palliative operation. The follow-up periods were 9 months, 3 and 10 years. Each patient underwent inhalation therapy, endoscopy and repeated stenting if necessary.
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Affiliation(s)
- M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Kozhevnikov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Samsonyan EK, Emelyanov SI, Kurganov IA, Bogdanov DY, Sekundova MA, Frolova EV, Bashirov RA. [Tracheobronchial stenting in patients with non-resectable tumors complicated by airway stenosis]. Khirurgiia (Mosk) 2022:41-49. [PMID: 36469467 DOI: 10.17116/hirurgia202212141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To study the results and efficiency of tracheobronchial stenting in patients with unresectable tumors complicated by stenosis of central airways. MATERIAL AND METHODS We analyzed the results of tracheobronchial stenting in 23 patients with unresectable tumors complicated by stenosis of central airways between 2016 and 2021. RESULTS Technical and clinical success rate was 100%. No intraoperative complications were noted. Dyspnea regressed in all patients in early postoperative period. Moreover, there was objective improvement in lung ventilation with increase in lung capacity (from 2.1±0.4 to 2.7±0.5 l; p<0.05), forced expiratory volume (from 1.2±0.5 to 1.8±0.4 l; p<0.05), partial pressure of oxygen in arterial blood (from 47±7.4 to 85±6.3 mm Hg; p<0.05) and arterial oxygen saturation (from 86.1±8.2 to 93.1±5.1%; p<0.05). One patient developed massive bleeding due to tumor decay on the 3rd day after surgery. In 2 patients, stent obturation with a «mucus plug» was observed after 2-3 postoperative days. In 3 months after surgery, 21.8% of patients had disturbances of external respiration accompanied by mild dyspnea due to granulation tissue growth. Stent migration in 3 months after endoscopic stenting was recorded in 1 patient. Three-month mortality was 26.1%. CONCLUSION Tracheobronchial stenting is a safe and effective minimally invasive surgical intervention. As a part of palliative care, this procedure improves functional and clinical parameters of pulmonary ventilation and reduces the incidence of complications. Thus, quality of life in patients with unresectable tumors complicated by airway stenosis is improved.
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Affiliation(s)
- E Kh Samsonyan
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Centrosoyuz Hospital of the Russian Federation, Moscow, Russia
| | - S I Emelyanov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I A Kurganov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D Yu Bogdanov
- Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M A Sekundova
- Centrosoyuz Hospital of the Russian Federation, Moscow, Russia
| | - E V Frolova
- Centrosoyuz Hospital of the Russian Federation, Moscow, Russia
| | - R A Bashirov
- Centrosoyuz Hospital of the Russian Federation, Moscow, Russia
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9
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Left main bronchus compression by aneurysm and kinking of the descending aorta. COR ET VASA 2021. [DOI: 10.33678/cor.2021.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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Yu Z, Wang J, Liang XH, Zhang BX, Yang XG, Yu L. Placing covered self-expanding metal stents by suspension laryngoscope in benign tracheal stenosis. Am J Otolaryngol 2021; 42:103040. [PMID: 33873046 DOI: 10.1016/j.amjoto.2021.103040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Tracheobronchial stent placement for malignant airway strictures has been proved to improve respiratory function, but experience for benign tracheobronchial stenoses is limited. The purpose of our study is to investigate the efficacy of covered expandable metallic stents, inserted through a suspension laryngoscope, treating tracheal stenosis following intubation or tracheostomy. METHODS From 2010 to 2018, 67 adult patients with the benign tracheal stenosis, underwent stent placement, using a suspension laryngoscope. According to the date of stent placement and stent caliber, these patients have been subdivided into two groups: Group 1 (from 2010 to 2013, stent caliber ranging from 16 to 20 mm) and Group 2 (from 2014 to 2018, stent caliber ranging from 18 to 22 mm). Complications, related reinterventions, and long-term prognosis were retrospectively evaluated. RESULTS Primary successful stent placement was achieved and symptoms were improved in all patients. Complications occurred in 27 (40.3%) cases. Among these, there were 14 (20.9%) cases with stent migration, 10 (14.93%) with granulation tissue formation and 3 (4.48%) with pneumonia. Stent migration in Group 1 was nearly 30% higher than that in Group 2 (P = 0.002). Five of the 8 patients who had placement of 16 mm stents had stent migration, more often than with 20 mm stents (P = 0.002). Ten patients' trachea had slight narrowing but without any symptoms. Six patients still had granulation tissue but without any growth at least two-year follow-up (2 patients whose stents were removed more than 1 year after placement). Even without tracheal narrowing and granulation tissue, 5 patients felt persistent shortness of breath. 92.5% of the patients reported to be satisfied with significant improvement in symptoms. CONCLUSIONS Patients with tracheal obstruction secondary to intubation or tracheostomy can benefit from tracheal stents. Placing 16 mm stents might lead to stent migration more easily than 20 mm stents. Tracheal stents placed by a suspension laryngoscope provide a reasonable alternative to open surgery for patients with benign tracheal stenosis or obstruction.
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Simonova MS, Rusakov MA, Parshin VD. [Airway complications after lung transplantation]. Khirurgiia (Mosk) 2021:77-83. [PMID: 34270198 DOI: 10.17116/hirurgia202107177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lung transplantations have been regularly performed in the Russian Federation since 2010. Therefore, the number of lung transplant recipients, as well as the number of patients with airway complications following lung transplantation has been increasing. Treatment of these patients takes place not only in transplantation centers, but also in other hospitals. This review is devoted to risk factors, clinical manifestations, treatment and prevention of airway complications after lung transplantation. We analyzed literature data over the last 15 years. It was confirmed that bronchoscopy is a «gold standard» for diagnosis of airway complications while bronchoscopic interventions are preferred for treatment. Balloon and rigid bronchodilation and endoscopic airway stenting are the most effective interventions. Silicone stents are the most optimal. Antimicrobial prophylaxis and timely use of antiproliferative immunosuppressive drugs are important factors in prevention and treatment of airway complications after lung transplantation.
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Affiliation(s)
- M S Simonova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Lin X, Ye M, Li Y, Zhou H, Chen C. A novel designed V-shaped silicone stent for the treatment of unilateral main bronchial stenosis V-shaped stent for bronchial stenosis. Ann Thorac Surg 2021; 113:e215-e218. [PMID: 34048757 DOI: 10.1016/j.athoracsur.2021.04.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 11/01/2022]
Abstract
Benign main bronchial stenosis may cause a potentially life-threatening condition. Airway silicone stenting is an important option of bronchoscopic treatments for patients with main bronchial stenosis. However, stent migration is one of the most frequent complications, which require repeated bronchoscopic interventions. To resolve this issue, we therefore in the report described a novel designed V-shaped silicone stent for the treatment of unilateral main bronchial stenosis. This method may be widely applied to clinical practice to prevent stent migration.
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Affiliation(s)
- Xiaoxiao Lin
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Min Ye
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Haixiao Zhou
- Department of Endoscopy, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China
| | - Chengshui Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, China.
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Rodriguez-Zapater S, Serrano-Casorran C, Guirola JA, Lopez-Minguez S, Bonastre C, de Gregorio MA. Reactivity study of a biodegradable polydioxanone tracheal stent in a rabbit model. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.arbr.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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14
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Shai SE, Lai YL, Tang HW, Hung SC. Treatment of stent-related fulminating granulation tissue via emergency tracheostomy under topical anesthesia. Asian J Surg 2020; 43:1172-1174. [PMID: 32988707 DOI: 10.1016/j.asjsur.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sen-Ei Shai
- Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; National Chi Nan University, Nantou, Taiwan
| | - Yi-Ling Lai
- Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Wen Tang
- Division of Thoracic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Chieh Hung
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of New Drug Development, China Medical University, Taichung Director, Integrative Stem Cell Center, China Medical University Hospital, Taichung, Taiwan.
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Rodriguez-Zapater S, Serrano-Casorran C, Guirola JA, Lopez-Minguez S, Bonastre C, de Gregorio MA. Reactivity Study of a Biodegradable Polydioxanone Tracheal Stent in a Rabbit Model. Arch Bronconeumol 2020; 56:643-650. [PMID: 32229053 DOI: 10.1016/j.arbres.2020.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/14/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The objective of this study was to evaluate tracheal reactivity induced by a biodegradable polydioxanone tracheal stent. MATERIALS AND METHODS Twenty-two rabbits were divided into 3 groups assigned to different survival times (30, 60 and 90days post-implantation). A biodegradable stent was implanted in each animal, except for 1 of each group (negative control). Implantation was performed through a small tracheotomy under fluoroscopic control. CT and histopathological studies were scheduled at the end of survival times. RESULTS No animal died during the procedure or follow-up. The stent had disappeared in 100% of the cases at 90days, in 50% at 60days, and in none at 30days. CT studies revealed a greater tracheal wall thickness at 30days than at 60 and 90days (1.60±0.41mm in the central part of the stent versus 1.11±0.18 and 0.94±0.11; P=.007, respectively). No granulomas were observed on histopathology. Some degree of histological changes were noted at 30days, which had reduced at 60 and 90days. Differences were also found in both CT and histology between animals in which the stent was present and animals in which it had degraded. CONCLUSIONS Polydioxanone stents produce a mild reaction that reverts with tracheal degradation. The use of these biodegradable stents in benign tracheal disease is promising.
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Affiliation(s)
- Sergio Rodriguez-Zapater
- GITMI, Grupo de Investigación en Técnicas de Mínima Invasión, Universidad de Zaragoza. DGA Gobierno de Aragón, Zaragoza, España
| | - Carolina Serrano-Casorran
- GITMI, Grupo de Investigación en Técnicas de Mínima Invasión, Universidad de Zaragoza. DGA Gobierno de Aragón, Zaragoza, España; Departamento de Patología Animal, Universidad de Zaragoza, Zaragoza, España.
| | - José A Guirola
- GITMI, Grupo de Investigación en Técnicas de Mínima Invasión, Universidad de Zaragoza. DGA Gobierno de Aragón, Zaragoza, España; Unidad de Radiología Intervencionista, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Sandra Lopez-Minguez
- GITMI, Grupo de Investigación en Técnicas de Mínima Invasión, Universidad de Zaragoza. DGA Gobierno de Aragón, Zaragoza, España
| | - Cristina Bonastre
- GITMI, Grupo de Investigación en Técnicas de Mínima Invasión, Universidad de Zaragoza. DGA Gobierno de Aragón, Zaragoza, España; Departamento de Patología Animal, Universidad de Zaragoza, Zaragoza, España
| | - Miguel A de Gregorio
- GITMI, Grupo de Investigación en Técnicas de Mínima Invasión, Universidad de Zaragoza. DGA Gobierno de Aragón, Zaragoza, España; Unidad de Radiología Intervencionista, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Criticality in tailoring the treatment for tracheoesophageal fistulas in children. Eur Arch Otorhinolaryngol 2019; 277:631-639. [PMID: 31707468 DOI: 10.1007/s00405-019-05720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Tracheo-oesophageal fistula (TOF) is a rare pathology. It can be congenital and concurrent with other congenital anomalies such as oesophageal atresia, laryngeal and tracheal agenesis, or it can be acquired. The purpose of this study was to analyse various management strategies and their outcomes in infants and children with TOF and identify potential areas for standardisation of the fistula repair procedures. METHODS At a single institution, a retrospective analysis of infants and children with congenital or acquired TOF between 2013 and 2019 was performed. Thirteen patients were identified. Data collection included: patient demography, associated congenital anomalies, details of fistula at the time of endoscopy, surgical approach and intra-operative findings, need for additional intervention(s), and outcomes. RESULTS Thirteen patients underwent endoscopic or open surgeries for correction of TOF. The TOF was congenital in ten patients and acquired in three patients. Eight patients had associated aero-digestive comorbidities, and six patients had systemic comorbidities. Three patients underwent endoscopic procedures and nine patients underwent an open TOF repair. One patient had tracheal agenesis and was not offered any treatment. Two patients required multiple endoscopic interventions for recurrent TOFs. Among four patients with prior tracheostomy, three were decannulated and one awaits decannulation. Conclusıon Appropriate case selection and surgical ergonomics are essential for patients with TOF to avoid recurrences. Preoperative endoscopy to obtain precise details regarding associated laryngotracheal lesions and demographics of the fistula is crucial.
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Bi Y, Zhu X, Yu Z, Wu G, Han X, Ren J. Clinical outcomes of metallic Y-shaped covered stents for bronchopleural fistula around upper carina after lobectomy. BMC Pulm Med 2019; 19:199. [PMID: 31690305 PMCID: PMC6833203 DOI: 10.1186/s12890-019-0973-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Few studies have reported the placement of metallic Y-shaped covered stents (Y stents) for bronchopleural fistula around the upper carina. METHODS Eighteen patients were treated with Y stents insertion under the guidance of fluoroscopy. All covered stents were custom-designed and inserted to fit the upper carina anatomy. Clinical data and medical imaging data were analyzed retrospectively. RESULTS The stents were implanted successfully for the first time in 17 patients, and one patient needed a second attempt due to stent migration during withdrawal of the guide wires. In total, 19 small Y single-plugged stents were inserted in the upper carina and 5 large Y stents additionally in the main carina. Nineteen complications were observed in 14 patients, including 4 major complications. Stents were successfully removed in 12 patients due to complications or cure efficacy, for a median duration in place of 89.5 days. One patient lost follow-up. Nine patients were cured, and three had clinical improvement. One patient died of ventricular fibrillation the second day after the procedure and 4 patients died of tumors 7.8 to 91.7 months after stent placement. The 1-, 3-, and 5-year survival rates were 87.5, 80.8 and 80.8%, respectively. CONCLUSIONS Metallic Y stent placement is technically feasible, effective and safe for bronchopleural fistula disease around the upper carina.
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Affiliation(s)
- Yonghua Bi
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Xiaoyan Zhu
- Department of Histology and Embryology, College of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Zepeng Yu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Gang Wu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China
| | - Xinwei Han
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.
| | - Jianzhuang Ren
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No.1, East Jian She Road, Zhengzhou, 450052, China.
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Diaz Milian R, Foley E, Bauer M, Martinez-Velez A, Castresana MR. Expiratory Central Airway Collapse in Adults: Corrective Treatment (Part 2). J Cardiothorac Vasc Anesth 2019; 33:2555-2560. [DOI: 10.1053/j.jvca.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 02/06/2023]
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Bronchial injuries: a tale of differing presentations. Indian J Thorac Cardiovasc Surg 2019; 35:245-248. [PMID: 33061017 DOI: 10.1007/s12055-018-00783-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/14/2018] [Indexed: 12/26/2022] Open
Abstract
Bronchial disruptions are uncommon but nevertheless grievous injuries and are usually secondary to major thoracic trauma. Although many are associated with other catastrophic injuries causing early mortality, their presentations can be late and they are often difficult to diagnose. Their management is frequently challenging and the ideal course of treatment is not yet clearly defined. Here, we describe two cases of main bronchial injuries presenting to us with post-traumatic collapse lung, albeit with a widely differing post-trauma course. Both required thoracotomy followed by a resection and anastomosis of the disrupted/stenotic segment. Operative results were good with both cases showing a well-expanded lung and no postoperative anastomotic site stenosis during the period of follow-up. Our experience highlights that patients with major bronchial injuries can have varying presentations. High degree of suspicion is necessary for early diagnosis and prompt surgical treatment. Resection of the stenosed/fibrosed segment followed by anastomosis yields good results.
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Wu X, Zhang X, Zhang W, Huang H, Li Q. Long-Term Outcome of Metallic Stenting for Central Airway Involvement in Relapsing Polychondritis. Ann Thorac Surg 2019; 108:897-904. [PMID: 30910657 DOI: 10.1016/j.athoracsur.2019.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Placement of uncovered self-expandable metallic stents was found to successfully alleviate critical airflow limitation in patients with relapsing polychondritis (RP) with central airway involvement by several reports. However, the long-term outcome of airway metallic stenting in patients with RP remain unclear. METHODS We retrospectively analyzed patients with RP who underwent airway metallic stenting with the use of fiberoptic bronchoscopy between September 1, 2009, and October 1, 2017, in Shanghai. Outcome measurements, including modified Medical Research Council (mMRC) dyspnea score, 6-minute walk distance (6MWD), spirometry, and bronchoscopic findings, as well as adverse events after stent placement, were collected. RESULTS A total of 27 patients were included; the median patient age was 58 years (range: 41 to 74 years), and 19 were men (70.4%). Nineteen uncovered self-expandable metallic stents were placed in the trachea and 39 in the main bronchi. The median follow-up time was 50.5 months (range: 6 to 100 months). The baseline forced expiratory volume in 1 second (FEV1) percentage predicted (%pred), FEV1/forced vital capacity (FVC), and peak expiratory flow (PEF) was 24.2 ± 3.7, 27.2 ± 5.6, and 0.99 ± 0.21 L/min, respectively. One day after the procedure, improvement from baseline in FEV1 %pred, FEV1/FVC, and PEF was 17.9 ± 8.9 (p = 0.001), 19.8 ± 10.9 (p = 0.002), and 0.69 ± 0.44 L/min (p = 0.001), respectively. Changes in the following variables were also statistically and clinically significant: 6MWD of 193.7 ± 83.4 m; mMRC dyspnea score of -1.2 ± 0.4 points (both p < 0.05). The improvements were maintained at 5 years: a mean change in FEV1 %pred, FEV1/FVC, PEF, 6MWD, and mMRC score was 19.5 ± 6.7, 13.9 ± 5.0, 0.82 ± 0.40 L/min, 134.7 ± 66.2 m, and -0.83 ± 0.29 points, respectively. Cough, foreign body sensation, mucus production, and granulomas were common adverse events, occurring in 48.1% (13 of 27), 40.7% (11 of 27), 29.6% (8 of 27), and 25.9% (7 of 27) of the subjects. However, none of those complications were severe enough to require urgent bronchoscopic interventions. CONCLUSIONS Airway metallic stenting in patients with RP with central airway involvement resulted in long-term clinical benefits in lung function, exercise tolerance, and dyspnea with an acceptable safety profile.
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Affiliation(s)
- Xiaodong Wu
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Xin Zhang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China; Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China.
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Long-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study. BMC Pulm Med 2019; 19:33. [PMID: 30736856 PMCID: PMC6368722 DOI: 10.1186/s12890-019-0793-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/25/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Self-expandable metallic stents (SEMSs) have enabled a approving management of malignant airway stenosis. However, the long-term efficacy and safety of this treatment in patients with benign airway stricture are unclear. We conducted this study to retrospectively determine the efficacy and long-term outcomes in patients who have undergone SEMS placement for benign tracheobronchial stenosis. METHODS All patients treated with SEMSs from July 2003 to June 2016 were reviewed for symptomatic response, complications, and long-term outcomes. RESULTS Total 131 stents were successfully deployed in 116 patients. Ninety-eight patients demonstrated clinical improvement after stent insertion (84.48%; 95% confidence interval [CI]: 77.89-91.07). Compared with uncovered stents, covered stents were associated with more sore throats complaints or chest pain (13.89% versus 28.81%, P = 0.036) and with higher incidences of major and minor granulation tissue formation and with recurrent stenosis (4.17% versus 15.25%, P = 0.029; 11.11% versus 37.29%, P < 0.0001 and 9.72% versus 28.81%, P = 0.005, respectively). Each covered and uncovered stent developing tissue hyperplasia required a median of 2 (range: 1-15) and 1(range: 1-7) fibrobronchoscope with electrocautery therapy, respectively. At follow-up (median: 1276 days; range: 2-4263), 68 patients had complete resolution, 15 remained under interventional treatment, 8 had bronchial occlusions, 7 underwent surgery, 14 were lost to follow-up, and 4 died of stent unrelated causes. CONCLUSION SEMS placement achieved most clinical improvement among patients in our study, if adequate endotracheal measures were used to address stent-related complications. The use of permanent SEMSs for benign tracheobronchial stenosis was effective and safe for the majority of patients in a long-term follow-up. TRIAL REGISTRATION The study has been retrospectively registered in the China Clinical Trial Registry on October 21, 2018 (Registry ID: ChiCTR1800019024 ).
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Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single-center study of 148 consecutive patients. Surg Endosc 2018; 32:4116-4124. [DOI: 10.1007/s00464-018-6152-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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Mondoni M, Repossi A, Carlucci P, Centanni S, Sotgiu G. Bronchoscopic techniques in the management of patients with tuberculosis. Int J Infect Dis 2017; 64:27-37. [PMID: 28864395 DOI: 10.1016/j.ijid.2017.08.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 12/27/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).
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Affiliation(s)
- Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Alice Repossi
- Respiratory Unit, Humanitas Gavazzeni Institute, Bergamo, Italy
| | - Paolo Carlucci
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Biomedical Sciences, University of Sassari, Sassari, Italy.
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Lee HJ, Labaki W, Yu DH, Salwen B, Gilbert C, Schneider ALC, Ortiz R, Feller-Kopman D, Arias S, Yarmus L. Airway stent complications: the role of follow-up bronchoscopy as a surveillance method. J Thorac Dis 2017; 9:4651-4659. [PMID: 29268534 DOI: 10.21037/jtd.2017.09.139] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Airway stenting has become an integral part of the therapeutic endoscopic management of obstructive benign and malignant central airway diseases. Despite increased use of airway stents and frequent stent-associated complications, no clear guidelines for surveillance and maintenance exist. This study aim is to elucidate predictive factors associated with development of stent complications, as well as an optimal surveillance period for follow-up bronchoscopy for early detection and possible prevention of stent-associated complications. Methods Retrospective cohort study of all patients who underwent airway stent placements at our institution from April 2010 to December 2013 for benign and malignant airway diseases. Metallic, silicone (straight, Y stent, T-tube) and hybrid stents were included in the study. Stent complications were analyzed at the time of follow-up bronchoscopy performed four to six weeks after initial stent placement or earlier if patients became symptomatic. Results The study included 134 patients of which 147 stents were placed. Follow-up bronchoscopy was performed in 94 patients. Symptomatic status at the time of follow-up bronchoscopy was not associated with stent complications [odds ratio (OR) =1.88; 95% CI: 0.79-4.45; P=0.15]. Patient age, sex, indication for stent placement, and stent location, were not associated with development of complications (all P>0.05). Compared to all other stents, hybrid stents were more likely to migrate (OR =6.60; 95% CI: 2.16-20.2; P=0.001) or obstruct by secretions (OR =2.53; 95% CI: 1.10-5.84; P=0.03). There were no complications associated with surveillance bronchoscopy. Conclusions Surveillance bronchoscopy within 4 to 6 weeks of stent placement may be useful for early detection of complications and their subsequent management, regardless of symptomatic status and indication for stent placement. Prospective multicenter studies are needed to compare optimal surveillance methods and the impact on patient mortality, morbidity and healthcare costs.
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Affiliation(s)
- Hans J Lee
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Wassim Labaki
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Diana H Yu
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Benjamin Salwen
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Christopher Gilbert
- Department of Thoracic Surgery, Section of Interventional Pulmonology, Swedish Medical Center Seattle, Seattle, WA, USA
| | - Andrea L C Schneider
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Ricardo Ortiz
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - David Feller-Kopman
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sixto Arias
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Lonny Yarmus
- Division of Pulmonary/Critical Care Medicine, Section of Interventional Pulmonology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Downey P, Middlesworth W, Bacchetta M, Sonett J. Recurrent and congenital tracheoesophageal fistula in adults†. Eur J Cardiothorac Surg 2017; 52:1218-1222. [DOI: 10.1093/ejcts/ezx164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/03/2017] [Indexed: 11/14/2022] Open
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Successful Treatment of an Iatrogenic Tracheal Laceration With a Temporary Polyurethane-Coated Nitinol Stent. Ann Thorac Surg 2017; 102:e11-2. [PMID: 27343518 DOI: 10.1016/j.athoracsur.2015.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/11/2015] [Accepted: 12/14/2015] [Indexed: 11/20/2022]
Abstract
We report the case of a 63-year-old woman who required emergent intubation after a choking episode at home. It resulted in a 5-cm tear in the membranous trachea. She was treated by placement of a temporary tracheal stent, which was successfully removed 3 months later.
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29
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López-Padilla D, García-Luján R, Puente Maestu L, de Miguel Poch E. Tracheobronchomalacia treatment: how far have we come? J Thorac Dis 2017; 8:3490-3493. [PMID: 28149540 DOI: 10.21037/jtd.2016.12.91] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Luis Puente Maestu
- Respiratory Department, Gregorio Marañón University Hospital, Madrid, Spain
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Cabañero A, Dronda F, Saldaña D, Hermida JM, Muñoz G, Moreno S. Management of a tracheoesophageal fistula in a patient with AIDS. Asian Cardiovasc Thorac Ann 2017; 25:226-228. [PMID: 28325073 DOI: 10.1177/0218492317696374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the high frequency of gastrointestinal complications and opportunistic infections in HIV-1 infected patients, tracheoesophageal (TEF) and bronchoesophageal (BEF) fístulas are rare. Our objective is to comunicate an additional and unusual case of TEF in an HIV-1-infected patient whose immunologic status was good with complete suppression of viral replication, so although uncommon, TEF/BEF of an infectious origen should be considered in AIDS. Endoscopic treatment with tracheal/esophageal stents is not without morbidity and mortality. As long as the patient can undergo reconstructive surgery, this should be the technique of choice.
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Affiliation(s)
- Alberto Cabañero
- 1 Department of Thoracic Surgery, University Hospital Ramón y Cajal, Madrid, Spain
| | - Fernando Dronda
- 2 Department of Infectious Disease, University Hospital Ramón y Cajal, Madrid, Spain
| | - David Saldaña
- 1 Department of Thoracic Surgery, University Hospital Ramón y Cajal, Madrid, Spain
| | - José Manuel Hermida
- 2 Department of Infectious Disease, University Hospital Ramón y Cajal, Madrid, Spain
| | - Gemma Muñoz
- 1 Department of Thoracic Surgery, University Hospital Ramón y Cajal, Madrid, Spain
| | - Santiago Moreno
- 2 Department of Infectious Disease, University Hospital Ramón y Cajal, Madrid, Spain
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Removal of Retrievable Self-Expandable Metallic Tracheobronchial Stents: An 18-Year Experience in a Single Center. Cardiovasc Intervent Radiol 2016; 39:1611-1619. [DOI: 10.1007/s00270-016-1420-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/07/2016] [Indexed: 12/18/2022]
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32
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Serrano C, Lostalé F, Rodríguez-Panadero F, de Blas I, Laborda A, Gregorio MAD. Tracheal Self-Expandable Metallic Stents: A Comparative Study of Three Different Stents in a Rabbit Model. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2015.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Geltner C, Likar R, Hausegger K, Rauter M. Management of Postintubational Tracheal Injury by Endoscopic Stent Placement: Case Report and Review of the Literature. Thorac Cardiovasc Surg Rep 2016; 5:8-12. [PMID: 28018811 PMCID: PMC5177452 DOI: 10.1055/s-0035-1570376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/16/2015] [Indexed: 11/04/2022] Open
Abstract
Endobronchial stent placement is a novel therapy for treatment of iatrogenic tracheal tears. A review of the available literature shows surgery and long-term intubation being the established treatment strategy. We describe the case of a 64-year-old woman with a tracheal rupture following endotracheal intubation for routine surgery. Pneumo-mediastinum and chest pain were the predominant symptoms. She was treated with a covered self-expandable metal stent that closed the tear and led to immediate symptom relief. After six weeks and complete healing of the trachea, the stent could be explanted. No stent complications occurred. A new algorithm for the treatment of these ruptures has been proposed.
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Affiliation(s)
| | - Rudolf Likar
- Anesthesia and Intensive Care, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Klaus Hausegger
- Department of Radiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Markus Rauter
- Department of Pulmonology, Klinikum Klagenfurt, Klagenfurt, Austria
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Perić I, Paladin I, Lozo Vukovac E, Vela Ljubić J, Gudelj I, Lozo M. Tracheomalatia, to stent or not to stent. Respir Med Case Rep 2015; 16:137-9. [PMID: 26744681 PMCID: PMC4682007 DOI: 10.1016/j.rmcr.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 09/26/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
Benign thyroid disorders such as goiter, especially retrosternal, can cause tracheostenosis by extrinsic tracheal compression, which is due to the lack of specific symptoms often misdiagnosed. Tracheomalatia develops as a result to long term tracheal compression and refers to weakness of the trachea characterized by softness of the tracheal cartilage arches and by loss of regular tracheal structure. Tracheomalatia is characterized by reduction of the endotracheal lumen and may affect the entire trachea or may be localized to one portion of it. We present the case of a 72-year old patient with distinct tracheostenosis and tracheomalatia, caused by long term pressure by the retrosternal goiter. We have been monitoring the patient for last 20 years after the second endotracheal stent had been placed. The first one was placed 34 years ago, in 1981. On both occasions granulation tissue and colonization of bacteria occurred. In the end the placed stents were rejected and migrated to the main carina. Despite the tracheal diameter narrower than 5 mm the patient has been living normally without the stent for 17 years, with the exception of no hard physical labor. He had a few short term antibiotic therapies and bronchial toilets during symptomatic deteriorations. Diagnosing retrosternal goiter and surgical treatment on time is of crucial importance in cases such as this one. Considering the complications caused by the stent, our opinion is that the majority of patients may require conservative treatment with closely monitoring during respiratory infections.
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Affiliation(s)
- Irena Perić
- Department of Pulmonary Diseases, University Hospital Center Split, Split, Croatia
| | - Ivan Paladin
- The Croatian Institute of Emergency Medicine, Split, Croatia
| | - Emilija Lozo Vukovac
- Department of Pulmonary Diseases, University Hospital Center Split, Split, Croatia
| | - Jadranka Vela Ljubić
- Department of Ear, Nose, Throat, Head and Neck Surgery, University Hospital Center Split, Split, Croatia
| | - Ivan Gudelj
- Department of Pulmonary Diseases, University Hospital Center Split, Split, Croatia
| | - Mislav Lozo
- Department of Cardiology, University Hospital Center Split, Split, Croatia
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Serrano C, Lostalé F, Rodríguez-Panadero F, Blas ID, Laborda A, de Gregorio MA. Tracheal Self-Expandable Metallic Stents: A Comparative Study of Three Different Stents in a Rabbit Model. Arch Bronconeumol 2015; 52:123-30. [PMID: 26141782 DOI: 10.1016/j.arbres.2015.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/20/2015] [Accepted: 04/20/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The objective of this study was to assess tracheal reactivity after the deployment of different self-expandable metal stents (SEMS). MATERIAL AND METHODS Forty female New Zealand rabbits were divided into four groups. Three groups received three different SEMS: steel (ST), nitinol (NiTi), or nitinol drug-eluting stent (DES); the fourth group was the control group (no stent). Stents were deployed percutaneously under fluoroscopic guidance. Animals were assessed by multi-slice, computed tomography (CT) scans, and tracheas were collected for anatomical pathology (AP) study. Data from CT and AP were statistically analyzed and correlated. RESULTS The DES group had the longest stenosis (20.51±14.08mm vs. 5.84±12.43 and 6.57±6.54mm in NiTi and ST, respectively, day 30; P<.05), and higher granuloma formation on CT (50% of cases). The NiTi group showed the lowest grade of stenosis (2.86±6.91% vs. 11.28±13.98 and 15.54±25.95% in DES and ST, respectively; P<.05). The AP study revealed that the ST group developed intense proliferative reactivity compared to the other groups. In the DES group, a destructive response was observed in 70% of the animals, while the NiTi was the least reactive stent. CT was more effective in detecting wall thickening (positive correlation of 68.9%; P<.001) than granuloma (not significant). CONCLUSIONS The ST group developed granulomas and significant stenosis. NiTi was the least reactive stent, while DES caused significant lesions that may be related to drug dosage. This type of DES stent is therefore not recommended for the treatment of tracheobronchial stenosis.
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Affiliation(s)
- Carolina Serrano
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Fernando Lostalé
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Francisco Rodríguez-Panadero
- Instituto de Biomedicina de Sevilla (IBIS), Hospital Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
| | - Ignacio de Blas
- Departamento de Patología Animal, Universidad de Zaragoza, Zaragoza, España
| | - Alicia Laborda
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Miguel Angel de Gregorio
- Grupo de Investigación en Técnicas de Mínima Invasión (GITMI) del Gobierno de Aragón, Universidad de Zaragoza, Zaragoza, España; CIBER Bioingeniería, Biomateriales y Nanomedicina (BBN), Zaragoza, España.
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Abstract
Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.
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Use of tracheal stenting in the palliation of anaplastic thyroid carcinoma: tertiary centre experience. The Journal of Laryngology & Otology 2015; 129:568-71. [PMID: 25990193 DOI: 10.1017/s0022215115001103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anaplastic thyroid carcinoma is rare but carries a poor prognosis. Anaplastic thyroid carcinoma leads to tracheal compression, airway compromise and eventually death. Airway compromise, a particularly distressing symptom, can be palliated with tracheal stenting. METHOD A retrospective case note analysis was conducted of patients diagnosed with anaplastic thyroid carcinoma between July 2003 and July 2013. RESULTS Twelve patients with anaplastic thyroid carcinoma were identified. Four patients underwent palliative tracheal stenting. Three patients had no dyspnoea at the time of stenting. Two stented patients subsequently developed dyspnoea secondary to stent migration; this was managed successfully with stent exchange. The other stented patient remained asymptomatic with regards to dyspnoea. All non-stented patients died with or from airway compromise. CONCLUSION Tracheal stenting is a relatively safe and effective method for palliation of distressing airway symptoms in patients with anaplastic thyroid carcinoma. Early prophylactic tracheal stenting in anaplastic thyroid carcinoma may be an effective option to prevent development of airway compromise as the disease progresses.
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Abstract
Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.
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Affiliation(s)
- Michael Machuzak
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jose F Santacruz
- Pulmonary, Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, TX 77030, USA
| | - Thomas Gildea
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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39
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Oltmanns U, Slade M. Tracheobronchial stenting. Br J Hosp Med (Lond) 2015; 72:318-24. [PMID: 21727810 DOI: 10.12968/hmed.2011.72.6.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Airway stenting can be a life-preserving intervention in patients with critical airway obstruction. It may be safely performed using flexible bronchoscopy under conscious sedation as a day-case procedure in selected patients, but a high incidence of complications limits its use to palliation of malignancy or bridging treatment in benign disease.
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Affiliation(s)
- Ute Oltmanns
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge
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40
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The temporary placement of endobronchial stents in the management of bronchial compression by transiently enlarged mediastinal structures. Int J Pediatr Otorhinolaryngol 2015; 79:271-3. [PMID: 25510988 DOI: 10.1016/j.ijporl.2014.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 11/21/2022]
Abstract
Enlargement of mediastinal structures can cause compression of the trachea and/or bronchi. We describe two case reports in which stenosis of left main bronchus, secondary to compression from an enlarged mediastinal structure, were successfully managed with temporary placement of a metallic self-expanding stent while waiting for the compression to relieve.
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41
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Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis 2014; 6:258-70. [PMID: 24624290 DOI: 10.3978/j.issn.2072-1439.2013.11.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/20/2013] [Indexed: 12/12/2022]
Abstract
Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management.
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Bilbao Ares A, Guelbenzu J, Castañeda M. [Endobronchial stent for the treatment of a traumatic rupture of the left bronchial due to a bull horn. Anesthetic implications]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:170-171. [PMID: 23725743 DOI: 10.1016/j.redar.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 04/03/2013] [Accepted: 04/06/2013] [Indexed: 06/02/2023]
Affiliation(s)
- A Bilbao Ares
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - J Guelbenzu
- Servicio de Cirugía Torácica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M Castañeda
- Servicio de Anestesia y Reanimación, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Dutau H, Musani AI, Plojoux J, Laroumagne S, Astoul P. The use of self-expandable metallic stents in the airways in the adult population. Expert Rev Respir Med 2014; 8:179-90. [PMID: 24450436 DOI: 10.1586/17476348.2014.880055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.
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Affiliation(s)
- Herve Dutau
- North University Hospital, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, 13015 France
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Heart, tracheo-bronchial and thoracic spine trauma. Succesful multidisciplinary management: a challenging thoracic politrauma. JOURNAL OF ACUTE DISEASE 2014. [DOI: 10.1016/s2221-6189(14)60055-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Choudhary C, Bandyopadhyay D, Salman R, Gildea T, Mehta A. Broncho-vascular fistulas from self-expanding metallic stents: A retrospective case review. Ann Thorac Med 2013; 8:116-20. [PMID: 23741275 PMCID: PMC3667440 DOI: 10.4103/1817-1737.109830] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/27/2013] [Indexed: 11/23/2022] Open
Abstract
To highlight a potentially fatal complication of broncho-vascular fistula arising from the self expanding metallic stent (SEMS) placement. We retrospectively analyzed five patients with benign and malignant airway diseases, who developed tracheo/broncho-vascular fistulas following SEMS placement in our tertiary care setting. All patients received either Wallstent or Ultraflex® stent (Boston Scientific, Natick, MA) between 1999 and 2007. All patients had received adjunct therapy such as balloon bronchoplasty, laser therapy or electrocautery. Most patients presented with massive hemoptysis. A total of 483 SEMS were placed during this period. SEMS placement can be complicated by Broncho-vascular fistula formation. True incidence and precise time interval between the insertion of stent and onset of this complication is unknown. Additional therapeutic modalities to maintain stent patency may enhance the risk of fistula formation. SEMS should only be used in a select sub-group of patients, after exhaustive evaluation of other treatment options. These cases provide evidence that broncho-vascular fistulas can develop at any time following SEMS placement, suggesting the need for a more cautious approach, especially while using them for a long term management. In benign airway disease, the stent should be removed as soon as healing has taken place.
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Affiliation(s)
- Chirag Choudhary
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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46
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McGrath EE, Warriner D, Anderson PB. Is stent insertion via flexible bronchoscopy a feasible alternative to surgery in inoperable thyroid related tracheobronchial stenosis? J Thorac Dis 2013; 5:302-5. [PMID: 23825763 PMCID: PMC3698266 DOI: 10.3978/j.issn.2072-1439.2013.04.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/03/2013] [Indexed: 11/14/2022]
Abstract
The use of endobronchial stents in the treatment of tumour related tracheobronchial stenosis has been well described. While many forms of stent exist, their use has invariably been described in the context of rigid bronchoscopy and general anaesthesia. Few reports exist on the use of endobronchial stents for the treatment of thyroid goitre related stenosis.Our objective was to retrospectively analyse the use of self expanding metal stent (SEMS) insertion for thyroid related tracheobronchial stenosis under sedation with flexible bronchoscopy in the treatment of this condition. Patient charts were reviewed on all patients who had stent insertion in our unit since 1999-2005. We analysed the indication for stenting, pathology, stent size and location and detail any complications of therapy. Particular attention was paid to those with benign disease to evaluate the recommendation made by the U.S Food and Drug Administration (FDA) in 2005 on the use of metal stents in benign airways disease. A total of five patients (4 female, 1 male) who were too unfit for surgery had stent insertion for thyroid related tracheobronchial stenosis over this period. All patients experienced complications which became prolonged and recurrent in those with benign disease who survived longer. We conclude that SEMS insertion via flexible bronchoscopy is not appropriate for the treatment of benign thyroid goitre related tracheobronchial stenosis until all other interventions have been exhaustively explored.
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Affiliation(s)
- Emmet E McGrath
- Department of Respiratory Medicine, Northern General Hospital, Sheffield S5 7AU, UK
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47
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Serrano C, Laborda A, Lozano JM, Caballero H, Sebastián A, Lopera J, de Gregorio MÁ. Metallic Stents for Tracheobronchial Pathology Treatment. Cardiovasc Intervent Radiol 2013; 36:1614-1623. [DOI: 10.1007/s00270-013-0602-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
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48
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Nair A, Godoy MC, Holden EL, Madden BP, Chua F, Ost DE, Roos JE, Naidich DP, Vlahos I. Multidetector CT and postprocessing in planning and assisting in minimally invasive bronchoscopic airway interventions. Radiographics 2013; 32:E201-32. [PMID: 22977038 DOI: 10.1148/rg.325115133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A widening spectrum of increasingly advanced bronchoscopic techniques is available for the diagnosis and treatment of various bronchopulmonary diseases. The evolution of computed tomography (CT)-multidetector CT in particular-has paralleled these advances. The resulting development of two-dimensional and three-dimensional (3D) postprocessing techniques has complemented axial CT interpretation in providing more anatomically familiar information to the pulmonologist. Two-dimensional techniques such as multiplanar recontructions and 3D techniques such as virtual bronchoscopy can provide accurate guidance for increasing yield in transbronchial needle aspiration and transbronchial biopsy of mediastinal and hilar lymph nodes. Sampling of lesions located deeper within the lung periphery via bronchoscopic pathways determined at virtual bronchoscopy are also increasingly feasible. CT fluoroscopy for real-time image-guided sampling is now widely available; electromagnetic navigation guidance is being used in select centers but is currently more costly. Minimally invasive bronchoscopic techniques for restoring airway patency in obstruction caused by both benign and malignant conditions include mechanical strategies such as airway stent insertion and ablative techniques such as electrocauterization and cryotherapy. Multidetector CT postprocessing techniques provide valuable information for planning and surveillance of these treatment methods. In particular, they optimize the evaluation of dynamic obstructive conditions such as tracheobronchomalacia, especially with the greater craniocaudal coverage now provided by wide-area detectors. Multidetector CT also provides planning information for bronchoscopic treatment of bronchopleural fistulas and bronchoscopic lung volume reduction for carefully selected patients with refractory emphysema.
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Affiliation(s)
- Arjun Nair
- Department of Radiology, St George's Hospital, London SW17 0QT, England.
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Chung FT, Lin SM, Chou CL, Chen HC, Kuo CH, Lin HC, Liu CY, Wang CH, Kuo HP, Yu CT. Complications of airway self-expandable metallic stent in benign airway diseases. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/abb.2013.41a016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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50
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Wilkey BJ, Alfille P, Weitzel NS, Puskas F. Anesthesia for Tracheobronchial Surgery. Semin Cardiothorac Vasc Anesth 2012; 16:209-19. [DOI: 10.1177/1089253212464715] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The airway is a crucial dynamic structure that spans different anatomical zones, including the intrathoracic, extrathoracic, tracheal, bronchial, and alveolar zones. Because of its vital role as the sole oxygen-conducting pathway to the alveoli, and hence to the human body, surgery involving any portion requires careful and specific planning by both the surgeon and the anesthesiologist. The review covers essential management points for proximal and distal tracheal procedures, including a discussion of tracheal stenting and tracheoplasty.
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Affiliation(s)
| | - Paul Alfille
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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