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Rausch M, Briault A, Aboussouan MP, Berger JE, Francony G, Atallah I. Endoscopic Removal of Uncovered Metallic Airway Stents. J Bronchology Interv Pulmonol 2024; 31:e0978. [PMID: 39210535 DOI: 10.1097/lbr.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Self-expandable uncovered metallic stents (SEUMS) have been used in benign tracheobronchial stenosis. Stent complications may require risky removal due to SEUMS integration in the tracheobronchial wall. Our study aims to report techniques, including a novel one, and outcomes of SEUMS removal by rigid bronchoscopy. METHODS We studied a case series of 7 patients from a tertiary medical center, who underwent SEUMS removal from 2017 to 2022. SEUMS removals were performed through rigid bronchoscopy. We used a new technique with bronchoscopic hook scissors to gradually dissect the stent from the airway wall. RESULTS Nine SEUMS were removed from 7 patients. The mean duration of stenting was 7 years (5 to 12 y). Indications for stent removal included mostly recurrent pulmonary infections, obstructive granulation tissue, and stents' fractures. We used the usually described technique in the literature known as the "piecemeal fashion" without dissection in 4 SEUMS removals and a new dissection technique in 5 procedures. We reported one major intraoperative complication using the former technique in the form of tracheal tear with mediastinal breach, while we did not experience any major complications with the later one. One patient died 8 days after surgery from respiratory failure. CONCLUSION Dissection and "piecemeal fashion techniques" can be used to remove SEUMS by rigid bronchoscopy even after long-term stenting. SEUMS removal is a very risky procedure and must be performed by a trained operator. Patients should be aware of possible severe complications.
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Affiliation(s)
- Mathilde Rausch
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital
- Grenoble Alpes University, School of Medicine, Domaine de la Merci
| | - Amandine Briault
- Grenoble Alpes University, School of Medicine, Domaine de la Merci
- Departments of Pulmonology
| | | | - Jean-Eric Berger
- Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital
| | - Gilles Francony
- Anesthesiology and Intensive Care Medicine, Grenoble Alpes University Hospital
| | - Ihab Atallah
- Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital
- Grenoble Alpes University, School of Medicine, Domaine de la Merci
- University of Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France
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Giordano D, Botti C, Castellucci A, Piro R, Ghidini A. Tracheal Stenosis after Tracheotomy for COVID-19. EAR, NOSE & THROAT JOURNAL 2024; 103:NP229-NP231. [PMID: 34625001 DOI: 10.1177/01455613211045539] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Davide Giordano
- Otolaryngology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- Department of Biomedical, Metabolic and Neural Sciences, Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Castellucci
- Otolaryngology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Piro
- Pneumology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Özdemir C, Kocatürk CI, Sökücü SN, Sezen BC, Kutluk AC, Bilen S, Dalar L. Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach. Ann Thorac Cardiovasc Surg 2018; 24:288-295. [PMID: 29877219 PMCID: PMC6300420 DOI: 10.5761/atcs.oa.18-00073] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis. Methods: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis. Results: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients. Conclusion: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.
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Affiliation(s)
- Cengiz Özdemir
- Department of Pulmonology, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celalettin I Kocatürk
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sinem Nedime Sökücü
- Department of Pulmonology, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Bugra Celal Sezen
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Cevat Kutluk
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Salih Bilen
- Department of Chest Surgery, Yedikule Chest Diseases and Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Dalar
- Department of Pulmonology, Istanbul Bilim University, Istanbul, Turkey
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Herrak L, Ahid S, Abouqal R, Lescot B, Gharbi N. Tracheal stenosis after intubation and/or tracheostomy. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
There is no universally valid definition of the extent of tracheal resections that would be considered "extended." Underlying disease, necessary length of resection, anatomic localization, and chosen surgical approach account for a manifold interdependency. Existing data suggest a "cutoff margin" of 4 cm or more, referring to the likelihood of complications and necessity of additional mobilization maneuvers. This overview outlines worldwide experiences and the surgical variety of possibilities, as well as their execution and appropriate use.
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Affiliation(s)
- Erich Hecker
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Academic Hospital University Duisburg-Essen, Hordeler Strasse 7-9, Herne 44651, Germany.
| | - Jan Volmerig
- Department of Thoracic Surgery, Thoraxzentrum Ruhrgebiet, Academic Hospital University Duisburg-Essen, Hordeler Strasse 7-9, Herne 44651, Germany
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Successful tracheal replacement in humans using autologous tissues: an 8-year experience. Ann Thorac Surg 2013; 96:1146-1155. [PMID: 23998399 DOI: 10.1016/j.athoracsur.2013.05.073] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/19/2013] [Accepted: 05/21/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fifty years of surgical research using synthetic materials and heterologous tissues failed to find a good, durable replacement for the trachea. We investigated autologous tracheal substitution (ATS) without synthetic material or immunosuppression. METHODS For ATS, we used a single-stage operation to construct a tube from a forearm free fasciocutaneous flap vascularized by radial vessels that was reanastomosed to internal mammary vessels and reinforced by rib cartilages interposed transversally in the subcutaneous tissue. Tracheal resections 7 to 12 cm long (mean, 11 cm) were done to treat 8 primary tracheal neoplasms, including 5 adenoid cystic carcinomas (ACC) and 3 squamous cell carcinomas (SCC); 3 secondary tracheal neoplasms, including 1 thyroid carcinomas and 2 lymphomas; and 1 postintubation tracheal destruction after a long history of stenting. Transitory tracheotomy was associated to the absence of mucociliary clearance. RESULTS ATS has been performed in 12 patients since 2004, with additional resections in 4 patients, comprising 1 carinal resection alone, 1 associated with lobectomy, and 2 pharyngolaryngectomies. All patients were extubated on postoperative day 1. Eight patients are alive at a mean of 36 months (range, 2 to 94 months) postoperatively, with no respiratory distress. The 2 patients with ATS and carinal resections died of pulmonary infection. No airway collapse has been detected by endoscopy, dynamic computed tomography scan, or spirometry. Two patients still have a tracheotomy because the procedure was performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency recently required a distal, short stent. CONCLUSIONS ATS is a good, durable, tracheal substitution that resists respiratory pressure variations because of transverse rigidity, without any immunosuppression.
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Autologous tracheal replacement: from research to clinical practice. Presse Med 2013; 42:e334-41. [PMID: 23993275 DOI: 10.1016/j.lpm.2013.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/10/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite numerous attempts, synthetic materials and heterologous tissues failed to replace durably the trachea. Autologous tracheal substitution (ATS) without synthetic material or immunosuppression was investigated to replace extended tracheal defect. We present our experience regards to this innovative challenge. METHOD After a previous research study, we developed a novel reconstruction technique for extended tracheal defects on animals. Through a single stage operation, a tube from a forearm free fascio-cutaneous flap vascularized by radial vessels is re-anastomosed to cervical vessels. This flap is reinforced by rib cartilages interposed transversally in the subcutaneous tissue. It provides also a reliable ATS. Twelve patients benefits from an extended tracheal resections, 7-12 centimeter (mean 11 cm) long. Indications were eight Primary tracheal Neoplasms (including 5 adenoid cystic carcinoma [ACC] and 3 squamous cell carcinoma [SCC]), three secondary tracheal neoplasms (including 1 thyroid carcinoma and 2 lymphoma) and one post-intubation tracheal destruction after long history of stenting. Daily bronchoscopy and transitory tracheotomy was associated due to absence of mucociliary clearance. RESULTS The research work leads to present the first described animal model for tracheal resection and replacement with an autologous conduit. It was constructed from costal cartilages and a pediculed cervical skin flap. From 2004 to 2012, 12 patients have had ATS with associated resections in four cases. All patients were extubated on the first postoperative days; eight patients are alive at 2 to 94 months (mean=36) postoperatively, with no respiratory distress. The two patients with ATS after resection extended to the carina died due to pulmonary infection. No airway collapse has been detectable, either by endoscopy, dynamic CT scan or spirometry. Two patients still have a tracheotomy because performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency required recently a distal and short stent. CONCLUSION ATS is actually a good, durable tracheal substitute that can resist respiratory pressure variations because of their transverse rigidity without any immunosuppression. The limits of this technique are probably, chronic respiratory insufficiency and cartilage calcifications. Research to develop a method for lining the neo-trachea with ciliated respiratory epithelium is needed.
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Bagheri R, Majidi M, Khadivi E, attar AS, Tabari A. Outcome of surgical treatment for proximal long segment post intubation tracheal stenosis. J Cardiothorac Surg 2013; 8:35. [PMID: 23452927 PMCID: PMC3599270 DOI: 10.1186/1749-8090-8-35] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post intubation long segment tracheal stenosis is a serious problem which usually requires multiple methods of treatment. The aim of this study was to evaluate the results of surgical treatment in long segment post intubation tracheal stenosis. METHODS Between 2004 to 2008, 20 patients with proximal long segment tracheal stenosis and resection of over 40% of tracheal length, were analyzed in terms of age, sex, clinical symptoms, etiology of stenosis, length of stenosis and resection, role of suprahyoeid release with bilateral hyoeid bone cutting maneuver, post operative complications and life quality 3 year after surgery. RESULTS M/F was 2/5, with the average age of 23.5 ± 0.5 years. Average length of stenosis was 4.2 ± 0.4 cm and the average length of resected segment was 5.2 ± 0.4 cm. Early postoperative complications occurred in 4 patients (20%), 5 patients (25%) had late stenosis and 4 of them were treated with multiple dilation and one patient needed tracheostomy and prolonged T. tube. We didn't have any mortality. 80% of patients had excellent surgical results in follow up period. CONCLUSION Surgery is the best method of treatment in long and multi segment tracheal stenosis.
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Affiliation(s)
- Reza Bagheri
- Cardio - Thoracic Surgery & Transplant Research Center, Emam Reza hospital, Faculty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Ferretti GR, Pison C, Righini C. [Volume CT: recent advances in acquired abnormalities of the trachea]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2007; 124:136-47. [PMID: 17481569 DOI: 10.1016/j.aorl.2007.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 01/29/2007] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To show the recent improvements in CT imaging of the trachea due to the introduction of multidetector computed tomography (MDCT). MATERIAL AND METHODS MDCT technology, which was introduced in the early 00's, allows acquiring the entire airways within few seconds while using low dose parameters thanks to the natural high contrast of the airways. RESULTS Volume acquisition with isotropic voxels offers an excellent anatomical resolution in all directions, improving the quality of multiplanar reformations and 3D reconstructions, including virtual bronchoscopy. Therefore, the ability of CT for detecting and localizing tracheal abnormalities are improved, which is useful for planning endoscopy or open surgery, or assess their results. Dynamic acquisition during expiration is the last refinement permitted by MDCT, which is of value to detect tracheomalacia. CONCLUSIONS MDCT is a non-invasive technique to image the trachea. Its applications are numerous, such as depiction of anatomical or functional abnormalities, evaluation of local extent of the disease, planning and assessing open surgery or interventional endoscopy.
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Affiliation(s)
- G-R Ferretti
- Service central de radiologie et imagerie médicale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Marel M, Pekarek Z, Spasova I, Pafko P, Schutzner J, Betka J, Pospisil R. Management of Benign Stenoses of the Large Airways in the University Hospital in Prague, Czech Republic, in 1998–2003. Respiration 2005; 72:622-8. [PMID: 16355003 DOI: 10.1159/000089578] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 09/07/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinically significant benign stenoses of the large airways develop in about 1% of patients after intubation. The management of benign stenoses is not unified around the world, nor are there any accepted methods for their screening. OBJECTIVES The purpose of this study is to describe and compare results of interventional bronchoscopy and surgical therapy of benign stenoses as well as to propose an algorithm for the management of this airways disorder. METHODS Prospective study on 80 consecutive patients with benign stenoses of the large airways admitted to the Pulmonary Department of the University Hospital of Prague-Motol. RESULTS Sixty-two patients developed stenoses after endotracheal intubation or tracheostomy, in 18 patients the stenosis was caused by other diseases or pathological situations. Thirty-eight patients were sent for surgical resection of the stenotic part of the airways. 2 surgically treated patients developed recurrence of the stenosis and had to be reoperated on. Narrowing of the trachea at the site of end-to-end anastomosis developed in 6 other patients and was cured by interventional bronchoscopy. The remaining 42 patients were treated by interventional bronchoscopy (Nd-YAG laser, electrocautery, stent) which was curative in 35 patients. Sixty-five patients were alive at the time of evaluation, 15 patients died. Five of them died between 3 and 14 (median 4) months after surgery from a disease other than airway stenosis. Ten nonresected patients also died, with 1 exception, due to a disease other than airway stenosis; the median survival was 9 months. CONCLUSIONS We recommend to assess the patient for surgery after the initial diagnosis and therapeutic bronchoscopy with dilatation of the stenosis. If the patient is not a suitable candidate for resection, interventional bronchoscopy is an appropriate alternative for the management of benign stenoses of the large airways.
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Affiliation(s)
- Miloslav Marel
- Pulmonary Department of the 1st Medical Faculty, Charles University, Katerinska 19, Prague 2, 120-00 Czech Republic.
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