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Chrissian AA, Diaz-Mendoza J, Simoff MJ. Restenosis Following Bronchoscopic Airway Stenting for Complex Tracheal Stenosis. J Bronchology Interv Pulmonol 2023; 30:268-276. [PMID: 35856939 DOI: 10.1097/lbr.0000000000000878] [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: 01/24/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonsurgical patients with complex postintubation tracheal stenosis (PITS) and tracheostomy-associated tracheal stenosis (PTTS) often require airway stenting. However, the optimal approach is unknown. Identifying patients at higher risk for restenosis after stent removal may allow the treating physician to individualize the vigilance and duration of airway stenting, and help optimize outcomes. METHODS This was a single-center retrospective analysis of prospectively collected data on all patients with complex PITS and/or PTTS treated with protocolized bronchoscopic airway stenting over a consecutive 16-year period. The primary outcome analyzed was restenosis rate at 1 year after stent removal. Predictors for restenosis and factors influencing risk for death during stent therapy were also assessed. RESULTS Of the 181 subjects treated with silicone airway stenting, 128 were available for analysis of the primary outcome. Restenosis by 1 year after stent removal occurred in 58%. Independent predictors for restenosis were coexisting diabetes [odd ratio (OR)=3.10, 95% confidence interval (CI)=1.04-9.24; P =0.04], morbid obesity (OR=3.13, 95% CI=1.20-8.17; P =0.02), and occurrence of stent-associated complications requiring bronchoscopic management (OR=2.13, 95% CI=1.12-4.03; P =0.02). The overall mortality during the initial stenting period was 14%, and a silicone Y-stent was associated with a higher risk of death (OR=3.58, 95% CI=1.40-9.14; P =0.008). CONCLUSION Tracheal restenosis after silicone stent therapy for complex PITS and PTTS is common and more likely to occur in patients with diabetes, morbid obesity, and frequent stent-associated complications. Mortality risk during stent therapy is not negligible, and a Y-stent should be utilized only after careful consideration. These findings may be incorporated into the approach to bronchoscopic airway stenting in these patients.
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Affiliation(s)
- Ara A Chrissian
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University, Loma Linda, CA
| | - Javier Diaz-Mendoza
- Division of Pulmonary and Critical Care, Interventional Pulmonology Section, Henry Ford Hospital
- Department of Internal Medicine, Wayne State University, Detroit, MI
| | - Michael J Simoff
- Division of Pulmonary and Critical Care, Interventional Pulmonology Section, Henry Ford Hospital
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Pulle MV, Asaf BB, Puri HV, Bishnoi S, Kumar A. Surgical intervention is safe, feasible, and effective in tubercular tracheobronchial stenosis. Lung India 2021; 38:245-251. [PMID: 33942749 PMCID: PMC8194432 DOI: 10.4103/lungindia.lungindia_343_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives: Posttubercular tracheobronchial stenosis is a troublesome sequela of tracheobronchial tuberculosis. Surgical resection is the treatment of choice when repeated bronchoscopic dilatations fail. Herein, we aim to present our surgical experience in the management of this problem and also to evaluate factors affecting the surgical outcomes. Materials and Methods: This is a retrospective analysis of a prospectively maintained database at a dedicated thoracic surgical unit in New Delhi, India, over 8 years. An analysis of demographic characteristics, perioperative variables including complications were carried out. The occurrence of postoperative complications, and/or hospital stay of >7 days was considered as “poor” surgical outcomes. Various parameters were analyzed to assess the factors predicting surgical outcomes. Results: A total of 20 patients were surgically managed in the study period. Two patients had tracheal stenosis. The left main bronchus was involved in 16 patients. In these 16 cases, 12 cases underwent lung preserving surgery (bronchial sleeve resection and sleeve lobectomy) and rest of 4 cases required pneumonectomy. All postoperative complications occurred in 5 (25%) patients. Prolonged air leak was the most common postoperative complication. On univariate analysis, surgical outcomes were poor in patients who had longer duration of symptoms (P = 0.03) and with >2 episodes of preoperative balloon dilatations (<0.001). On multivariate analysis, “total number of dilatations <4 times,” emerged as a significant predictive factor for lung preservation surgery. Conclusions: Surgical intervention is safe, feasible, and effective in tubercular tracheobronchial stenoses which fail to respond to bronchoscopic interventions. Early referral for surgery favors lung preservation.
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Affiliation(s)
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Huang W, Shan Q, Wu Z, Li H, Zhou M, Ding X, Wang Z. Retrievable covered metallic segmented Y airway stent for gastrorespiratory fistula of carina or main bronchi. J Thorac Cardiovasc Surg 2020; 161:1664-1671.e2. [PMID: 32340805 DOI: 10.1016/j.jtcvs.2020.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/07/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the feasibility of new retrievable covered metallic segmented Y airway stents modified with 3-dimensional (3D) printing for gastrorespiratory fistula involving carina or main bronchi. METHODS We designed a new retrievable covered metallic segmented Y airway stent to fit the anatomical characteristics of the carina region in individual patients. All stents were individually customized based on a 3D-printed mold. Six patients with gastrorespiratory fistula and aspiration pneumonia after esophagectomy underwent the stent implantation. The stents were retrieved when the fistula was cured or stent-related complications occurred. RESULTS Seven Y stents were successfully implanted and removed in 6 patients. All stents expanded well, and the fistulas were completely sealed. Aspiration pneumonia was controlled in 6 patients. The median Karnofsky Performance Status scores significantly improved after stenting compared with those before stent implantation (P = .024). Sputum retention was the most common complication after stenting and was treated with aspiration under bronchoscopy (33.33%). Excessive granulation tissue proliferation was found in 1 patient (16.7%) and was treated with cryotherapy. The indwelling time of the stent was 64 days (interquartile range, 52-69 days). After stent removal, bronchoscopy, gastroscopy, and computed tomography of the chest showed cured fistulas in all patients, and no stents showed fractures. CONCLUSIONS Retrievable covered metallic segmented Y airway stents modified with 3D printing appear to be feasible for the treatment of gastrorespiratory fistula involving carina or main bronchi.
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Affiliation(s)
- Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qungang Shan
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Abstract
Airway stent implantation is a highly effective treatment for airway stenosis. However, it is presently unclear whether patients with airway stents can safely undergo magnetic resonance imaging (MRI). Such stents may be metallic or non-metallic, and MRI may induce stent dislodgment or heating and may be associated with stent-induced artifacts. We thoroughly reviewed the literature, experimental data, and manufacturer information on non-metallic, stainless steel (SS) and nickel-titanium alloy stents. Non-metallic stents are made of non-ferromagnetic materials associated with no MRI concerns. SS stents may shift in a magnetic field, generating significant artifacts. Nickel-titanium alloy stents are not at risk of dislodgement or heating, but may create some artifacts affecting image quality. Both non-metallic and nickel-titanium alloy stents are safe for patients who must undergo MRI. However, the safety of SS stents depends on the type of steel used.
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Affiliation(s)
- Yang Xia
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Rui Jin
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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Li N, Zhu L, Sun J, Pan Y, Gao M. Difficulty in tracheal extubation followed by tracheal collapse after balloon dilatation for tracheal stenosis therapy: A case report. Medicine (Baltimore) 2018; 97:e10907. [PMID: 29851818 PMCID: PMC6393024 DOI: 10.1097/md.0000000000010907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Tracheobronchomalacia (TBM) refers to the weakening trachea or the trachea loss of structural integrity of airway cartilaginous structures. It causes tracheal stenosis, resulting in significantly high rates of mortality. Bronchoplasty by high-pressure balloon dilation under general anesthesia is a simple but effective and safe method to treat tracheobronchial stenosis. However, recurrent postoperative dyspnea after extubation due to tracheal collapse is still a challenge for anesthetists. PATIENT CONCERNS A 52-year-old man weighing 72 kg was scheduled for balloon dilatation surgery under general anesthesia because of breathing difficulties caused by tracheal stenosis. His previous medical history included rheumatoid arthritis, obstructive sleep apnea syndrome (OSAS), chronic bronchitis and a history of tracheal intubation. Laryngeal computerized tomography confirmed the stenosis at the level of thyroid gland. DIAGNOSIS The tracheal collapse after balloon dilatation for tracheal stenosis therapy. INTERVENTIONS Postoperatively, the patient presented with more serious and repetitive symptoms of dyspnea after extubation when compared to that before treatment. So, we had to re-insert the laryngeal mask airway (LMA), and exclude some anesthesia-associated factors, such as laryngospasm, bronchospasm and so on. After a series of treatments, we ultimately found the cause in time (the airway collapsed), and succeeded in tracheal extubation after the stent was inserted. OUTCOMES The patient recovered well and reported high satisfaction with anesthesia management. LESSONS In such an emergency even, the anesthesiologist should take valuable treatments to ensure the patient's effective ventilation. If the anesthesia-related factors can be eliminated, tracheomalacia or airway collapse should be considered whenever dyspnea occurs in the patients who unexpectedly fail to be extubated.
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Lee KH, Rutter MJ. Role of Balloon Dilation in the Management of Adult Idiopathic Subglottic Stenosis. Ann Otol Rhinol Laryngol 2017; 117:81-4. [DOI: 10.1177/000348940811700201] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives We evaluated the efficacy of balloon dilation for adjunctive and symptomatic management of isolated idiopathic subglottic stenosis in adults. Methods Adults with airway obstruction symptoms classified as idiopathic subglottic stenosis based on history and findings of a single discrete stenotic area on microlaryngoscopy and bronchoscopy were included in this series. Patients who met these criteria underwent dilation with a 10- to 14-mm balloon in a single procedure or in 2 consecutive dilations within 7 days. The patients were followed for up to 30 months after dilation. Results Six patients met the criteria. One of the 6 had prior laser treatments and a cricotracheal resection. One patient had a previous scar band lysis procedure. The remaining 4 patients had no prior procedures. The airway sizes prior to dilation ranged from a 2.5 endotracheal tube to a 5.0 endotracheal tube. In all cases the airway was dilated to 2.0 to 3.5 endotracheal tube sizes larger than the initial size. To date, 4 patients have been followed for 10 to 30 months without symptoms of recurrent airway stenosis. One patient was symptom-free for 22 months, then presented with progressive airway difficulty following an upper respiratory tract infection, and has undergone a repeat dilation. No patients had adverse effects or complications from the procedure. Conclusions Balloon dilation of idiopathic subglottic stenosis in adults is a relatively safe and effective method to manage this disease entity for cases of isolated and discrete lesions. Patients who underwent a single procedure have remained symptom-free for up to 30 months after balloon dilation.
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Affiliation(s)
- Kenneth H. Lee
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael J. Rutter
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Li D, Li X, Yan X, Gu Y, Yang X, Meng F. Perioperative nursing of tracheal silicon stent implantation in infants: report on four cases. J Matern Fetal Neonatal Med 2017; 31:3328-3331. [PMID: 28805096 DOI: 10.1080/14767058.2017.1368073] [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: 10/19/2022]
Abstract
AIMS To report experience of perioperative nursing of tracheal silicon stent implantation in infants. METHODS Retrospective analysis on the cases of tracheal silicon stent implantation in infants in our hospital. RESULTS AND CONCLUSIONS Since middle of 2014, totally four tracheal silicon stent implantation were performed in our center. Of them, one case was recurrent tracheoesophageal fistula and the other three cases were traheomalacia. Parent's psychological support, infants' nutrition support and airway care were key responsibility for a nurse before implantation. During the procedure of stent implantation, it was responsible for a nurse to closely monitor the infants and to support operator. After the implantation, airway care and prevention of intra-airway bacterial colonization were important to avoid complications.
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Affiliation(s)
- Deli Li
- a Second Department of Pediatric Respiration , The First Hospital of Jilin University , Changchun , China
| | - Xiaoqing Li
- a Second Department of Pediatric Respiration , The First Hospital of Jilin University , Changchun , China
| | - Xiuli Yan
- b Department of Neurology , The First Hospital of Jilin University , Changchun , China
| | - Yue Gu
- c Department of Hepatopancreatobiliary Surgery , The First Hospital of Jilin University , Changchun , China
| | - Xueqin Yang
- d Department of Traditional Chinese Medicine , The First Hospital of Jilin University , Changchun , China
| | - Fanzheng Meng
- a Second Department of Pediatric Respiration , The First Hospital of Jilin University , Changchun , China
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Ulusan A, Sanli M, Isik AF, Celik İA, Tuncozgur B, Elbeyli L. Surgical treatment of postintubation tracheal stenosis: A retrospective 22-patient series from a single center. Asian J Surg 2017; 41:356-362. [PMID: 28412038 DOI: 10.1016/j.asjsur.2017.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE We aimed to present cases of postintubation tracheal stenosis (PITS), all due to long-term intubation and treated surgically in a university hospital, and to discuss them in light of the literature. METHODS In this retrospective study, 22 patients who were treated with tracheal resection and reconstruction due to PITS were included. Demographics, intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded. RESULTS The mean intubation duration was 16.95 days with a median of 15.00 days. Collar incision was applied in 19 cases (86.4%); in two cases (9.1%) a median sternotomy incision was used; and in the remaining case (4.5%), a right thoracotomy incision was made. The mean tracheal stenosis length was 2.14 cm (mean excision length, 2.5 cm). In 17 cases (77.3%), the anterior walls were supported with vicryl (polyglactin) suture one by one. No postoperative complications were observed in 12 cases (54.5%). No recurrence developed during the long-term follow-up of 15 of the 22 patients (68.2%). Two patients (9.1%) died in the early stages after surgery, and five patients (22.7%) had a stent inserted due to restenosis. CONCLUSION Tracheal resection and end-to-end anastomosis are the most efficient techniques in cases without medical contraindications, despite emerging stent or endoscopic procedures. Endoscopic interventions can be suggested as an alternative to surgery in patients for whom surgery cannot be performed or who develop recurrence.
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Affiliation(s)
- Ahmet Ulusan
- Department of Thoracic Surgery, Hitit University Corum Education and Research Hospital, Corum, Turkey.
| | - Maruf Sanli
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Ahmet Feridun Isik
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - İlknur Aytekin Celik
- Thoracic Surgery Clinic, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Bulent Tuncozgur
- Department of Thoracic Surgery, Ankara Guven Hospital, Ankara, Turkey
| | - Levent Elbeyli
- Department of Thoracic Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
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Abstract
Modern thoracic surgery can now offer management of tuberculosis and its complications in selected patients with greater efficacy and less morbidity than ever before. Significantly, newer minimally invasive thoracic surgical approaches potentially lower thresholds for surgical candidacy, allowing more tuberculosis patients to receive operative treatment. This review aims to provide an overview of the role that modern thoracic surgery can play in diagnosing and managing patients with tuberculosis and its sequelae.
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Medhi J, Handique A, Goyal A, Lynser D, Phukan P, Sarma K, Padmanabhan A, Saikia MK, Chutia H. Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique. Indian J Radiol Imaging 2016; 26:103-7. [PMID: 27081233 PMCID: PMC4813059 DOI: 10.4103/0971-3026.178357] [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] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. MATERIALS AND METHODS We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. RESULTS We achieved technical success in all the three patients with immediate relief of dyspnea. CONCLUSION Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort.
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Affiliation(s)
- Jayanta Medhi
- Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Akash Handique
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Amit Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Donbok Lynser
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Pranjal Phukan
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Kalyan Sarma
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Aswin Padmanabhan
- Department of Radiology and Imaging, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Manuj Kumar Saikia
- Department of Cardiothoracic and Vascular Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Happy Chutia
- Department of Biochemistry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Shin JH, Baek JH, Oh YM, Ha EJ, Lee JH. Combination therapy of temporary tracheal stenting and radiofrequency ablation for multinodular thyroid goiter with airway compression. Korean J Radiol 2013; 14:805-9. [PMID: 24043977 PMCID: PMC3772263 DOI: 10.3348/kjr.2013.14.5.805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 06/27/2013] [Indexed: 01/01/2023] Open
Abstract
We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.
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Affiliation(s)
- Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea
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Achkar J, Dowdal J, Fink D, Franco R, Song P. Balloon Dilation Complication during the Treatment of Subglottic Stenosis: Background of the FDA Class 1 Recall for the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System. Ann Otol Rhinol Laryngol 2013; 122:364-8. [DOI: 10.1177/000348941312200603] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Balloon dilation for subglottic stenosis allows for a controlled radial expansion of the airway and is considered superior to older techniques of airway dilation. We report the case of a 39-year-old woman with idiopathic subglottic stenosis who had entrapment of an inflated balloon in her subglottis due to device failure while undergoing balloon dilation of the stenotic area. Methods: We present a case report and a review of the literature. Results: As a result of this and other reported incidents, on March 13, 2012, the US Food and Drug Administration issued a class 1 recall of the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System (Acclarent Inc, Menlo Park, California). Conclusions: This is the first report describing a dislodged inflated balloon in the subglottis as a complication of dilation for idiopathic subglottic stenosis. Awareness of this possibility, as well as preparedness with the proper instruments, is vital for prevention of a catastrophic emergency during an otherwise low-risk procedure.
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Isolated Tuberculous Lymphadenitis With Tracheal Involvement in an Elderly Patient. J Bronchology Interv Pulmonol 2013; 20:175-8. [DOI: 10.1097/lbr.0b013e31828f4a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Verma A, Park HY, Lim SY, Um SW, Koh WJ, Suh GY, Chung MP, Kwon OJ, Kim H. Posttuberculosis tracheobronchial stenosis: use of CT to optimize the time of silicone stent removal. Radiology 2012; 263:562-8. [PMID: 22371608 DOI: 10.1148/radiol.11111463] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate whether air pockets (tracheobronchial air columns in the space between the outer surface of the stent and the adjacent airway wall) discernible at computed tomography (CT) can help optimize the time of stent removal in patients with posttuberculosis tracheobronchial stenosis (PTTS). MATERIALS AND METHODS The study was approved by the institutional review board, and informed consent was obtained from all patients. Data from 41 patients (five men, 36 women) with a median age of 39 years (range, 21-64 years) who underwent silicone stent placement owing to PTTS, followed by CT and stent removal 6-12 months after clinical stabilization, were investigated retrospectively. Two radiologists determined whether the extent of air pockets on CT scans was associated with clinical success, which was defined as maintenance of a prosthesis-free airway for more than 2 years after stent removal. Radiologic features were compared for outcome by using a Wilcoxon two-sample test or Fisher exact test. RESULTS Stents were removed successfully in 31 patients (76%). Air pockets longer than 1 cm or longer than 2 cm were associated with successful stent removal (P = .04 and P = .006, respectively). The sensitivity and specificity of air pocket length in the prediction of successful stent removal were 84% and 50%, respectively, for air pockets longer than 1 cm and 68% and 70% for air pockets longer than 2 cm. CONCLUSION The extent of air pockets at chest CT shows correlation with the success of stent removal, indicates regression of stenosis, and may help guide the optimal time for stent removal.
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Affiliation(s)
- Akash Verma
- Department of Medicine, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
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Xue Q, Wang N, Xue X, Wang J. Endobronchial tuberculosis: an overview. Eur J Clin Microbiol Infect Dis 2011; 30:1039-44. [PMID: 21499709 DOI: 10.1007/s10096-011-1205-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 02/25/2011] [Indexed: 12/30/2022]
Abstract
Endobronchial tuberculosis (EBTB), of which the incidence has been increasing in recent years, is a special type of pulmonary tuberculosis. The endobronchial tuberculose focuses often injure the tracheobronchial wall and lead to tracheobronchial stenosis. The tracheobronchial stenosis may cause intractable tuberculosis and make patients become chronic infection sources of tuberculosis, or may even cause pulmonary complications and result in death. The etiological confirmation of Mycobacterium tuberculosis is most substantial for diagnosis. However, because the positive rate of acid-fast bacillus staining for sputum smears is low and the clinical and radiological findings are usually nondistinctive, the diagnosis of EBTB is often mistaken and delayed. For early diagnosis, a high index of awareness of this disease is required and the bronchoscopy should be performed as soon as possible in suspected patients. The eradication of Mycobacterium tuberculosis and the prevention of tracheobronchial stenosis are two most substantial treatment goals. To get treatment goals, the diagnosis must be established early and aggressive treatments must be performed before the disease progresses too far.
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Affiliation(s)
- Q Xue
- Respiratory Diseases Department , Chinese PLA General Hospital, 28 Fuxing Rd, 100853 Beijing, China
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Abstract
PURPOSE OF REVIEW Malignant central airway obstruction heavily impacts patients' quality of life and its management continues to be a challenge. The current article will review the use of airway stents in this population. RECENT FINDINGS Airway stenting is highly effective in palliating symptoms of airway obstruction. There are several types of stents available with different advantages and disadvantages depending mainly on the material they are made from. Clinical outcomes seem to be comparable between silicone and self-expanding metal stents. Self-expanding metal stents have proven to be efficient in recanalizing 'complex' central airway obstructions. Preliminary data show that a new self-expanding 'hybrid' stent appears to be effective and safe for malignant airway obstruction. Airway stent complications vary according to the type of stent and the type of obstruction. Multidetector computed tomography seems to be a valuable adjunct to bronchoscopy in detecting and characterizing stent complications. A clear definition of airway stent-related infection is urgently needed to provide adequate diagnosis and management of this complication. Metal stent fracture is less common in patients with malignant airway obstruction as compared with benign disease, and this could be partially explained by the decreased survival and shorter exposure to stent in the former population. SUMMARY Airway stents are of great help in palliating symptoms of malignant central airway obstruction. Unfortunately, there have been no recent striking advances in stent technology and the ideal stent has yet to be designed.
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SIHOE AD, SHIRAISHI Y, YEW WW. The current role of thoracic surgery in tuberculosis management. Respirology 2009; 14:954-68. [DOI: 10.1111/j.1440-1843.2009.01609.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Guzman DSM, Mitchell M, Hedlund CS, Walden M, Tully TN. Tracheal resection and anastomosis in a mallard duck (Anas platyrhynchos) with traumatic segmental tracheal collapse. J Avian Med Surg 2007; 21:150-7. [PMID: 18065138 DOI: 10.1647/1082-6742(2007)21[150:traaia]2.0.co;2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A male mallard duck (Anas platyrhynchos) presented for examination for acute respiratory distress and lethargy. The duck had experienced recurrent episodes of respiratory distress since being attacked by a raccoon the previous year, resulting in neck lacerations. Diagnostic tests, including a complete blood count, plasma biochemical analysis, radiography, and tracheoscopy, revealed a collapsed trachea. Surgical correction of the collapsed tracheal segment resulted in resection of 9% of the total tracheal length and subsequent anastomosis. Tracheoscopy performed 2 and 3 months after surgery revealed a healthy mucosa, minimal reduction of the tracheal lumen in the area of anastomosis, and minimal suture granuloma formation.
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Affiliation(s)
- David Sanchez-Migallon Guzman
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803-8410, USA
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20
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Bodhey NK, Gupta AK, Neelakandhan KS, Neema PK, Kapilamoorthy TR, Purkayastha S, Thomas B, Krishnamoorthy T, Kesavadas C. Fluoroscopic-guided balloon dilatation and stenting in tracheal stenosis with metallic self-expandable stents and long-term follow-up results. ACTA ACUST UNITED AC 2007; 51:351-7. [PMID: 17635472 DOI: 10.1111/j.1440-1673.2007.01749.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to assess the safety and long-term efficacy of self-expandable stents in the treatment of benign tracheal stenosis. Nine patients (seven men) with tracheal stenosis (including one with fistula) of varied cause were treated by fluoroscopically guided balloon dilatation and stenting with self-expandable metallic stents. The procedure was carried out under topical spray in eight patients and under general anaesthesia in one patient. The patients were followed up for a period ranging between 13 and 60 months. In eight of the nine patients, satisfactory positioning of the stent was achieved at the first instance, with immediate relief of dyspnoea. One patient with innominate artery aneurysm died 16 days after the procedure because of renal failure. At 1 month of follow up, six out of eight (75%) of our live patients were without any respiratory embarrassment. This dyspnoea-free result reached almost 90% by the end of 1 year especially so in the fibrous strictures. Four out of the eight live patients (50%) had cough for 2 months and two (25%) had mild blood-tinged sputum treated by inhalation and mucolytic agents. Secondary intervention was required in one patient at 1 month because of recurrent symptoms. The patient with tracheo-oesophageal fistula required surgical intervention because of fracture of the stent. Fluoroscopically guided balloon dilatation and stenting of the tracheal stenosis is an effective non-surgical therapy resulting in cure of fibrous strictures and palliation in cases of malignancy.
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Affiliation(s)
- N K Bodhey
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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21
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Smati B, Boudaya MS, Ayadi A, Ammar J, Djilani H, El Mezni F, Kilani T. Tuberculosis of the trachea. Ann Thorac Surg 2006; 82:1900-1. [PMID: 17062274 DOI: 10.1016/j.athoracsur.2006.02.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 02/05/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Abstract
Tracheal tuberculosis is an uncommon localized form of tuberculosis with fewer than 150 reported cases in the literature. We report a case of tracheal stenosis caused by tuberculosis in which the diagnosis was suggested by the patient's past medical history. This patient was successfully treated with tracheal resection, adjuvant steroids and anti-tuberculous therapy. This report will review the various types of tuberculosis of the trachea and their clinical features in addition to discussing the different available treatment modalities.
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Affiliation(s)
- Belhassen Smati
- Department of Thoracic Surgery, Abderrahmen Mami Hospital, Ariana, Tunisia.
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Iwamoto Y, Miyazawa T, Kurimoto N, Miyazu Y, Ishida A, Matsuo K, Watanabe Y. Interventional Bronchoscopy in the Management of Airway Stenosis Due to Tracheobronchial Tuberculosis. Chest 2004; 126:1344-52. [PMID: 15486402 DOI: 10.1378/chest.126.4.1344] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To assess the efficacy and complications of interventional bronchoscopic techniques in treating airway stenosis due to tracheobronchial tuberculosis. DESIGN Case series. SETTING Respiratory care centers at two tertiary care referral teaching hospitals in Japan, Hiroshima City Hospital and Okayama Red Cross Hospital. PATIENTS AND INTERVENTIONS A total of 30 patients were admitted to the hospital with a diagnosis of tracheobronchial tuberculosis between January 1991 and January 2002. Of those 11 patients received interventional bronchoscopy, including stent placement, laser photoresection, argon plasma coagulation (APC), balloon dilatation, cryotherapy, and endobronchial ultrasonography (EBUS). One patient with complete bronchial obstruction underwent a left pneumonectomy. RESULTS Six patients underwent stent placement after balloon dilatation, while the remaining five patients underwent only balloon dilatation. In six patients, Dumon stents were successfully placed to reestablish the patency of the central airways. Two patients first had Ultraflex stents implanted but had problems with granulation tissue formation and stent deterioration caused by metal fatigue due to chronic coughing. Dumon stents then were placed within the Ultraflex stents after the patient had received treatment with APC and mechanical reaming using the bevel of a rigid bronchoscope. In four patients, EBUS images demonstrated the destruction of bronchial cartilage or the thickening of the bronchial wall. The main complications of Dumon stents are migration and granulation tissue formation, necessitating stent removal, or replacement, and the application of cryotherapy to the granuloma at the edge of the stent. CONCLUSION Interventional bronchoscopy should be considered feasible for management of tuberculous tracheobronchial stenosis. Dumon stents seem to be appropriate, since removal or replacement is always possible. Ultraflex stents should not be used in these circumstances because removal is difficult and their long-term safety is uncertain. EBUS could provide useful information in evaluating the condition of the airway wall in cases of tracheobronchial tuberculosis with potential for bronchoscopic intervention.
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Affiliation(s)
- Yasuo Iwamoto
- Department of Pulmonary Medicine, Hiroshima City Hospital, 7-33 Naka-Ku, Moto-machi, Hiroshima City, Hiroshima Prefecture, 730-8518 Japan
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24
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Affiliation(s)
- Jay B Brodsky
- Department of Anesthesia, Stanford University Medical Center School of Medicine, CA 94305, USA.
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25
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Mostafa BE. Endoluminal stenting for tracheal stenosis. Eur Arch Otorhinolaryngol 2003; 260:465-8. [PMID: 12732934 DOI: 10.1007/s00405-003-0624-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2002] [Accepted: 04/03/2003] [Indexed: 10/26/2022]
Abstract
This prospective clinical study evaluates the role of endoluminal stents in the maintenance of a tracheal lumen after management of stenosis. Tracheal stenosis may be due to a variety of causes, and it is a significant health problem. Most patients either remain tracheostomized for prolonged periods of time or undergo several major surgical interventions. The most common sequel is restenosis at the site of repair either after augmentation or resection anastomosis. In this study, 16 patients with different pathologies causing tracheal stenosis or collapse are presented. All patients had the tracheal lumen re-established either endoscopically or by an open procedure. The stent was then placed to support the site of repair and prevent restenosis. A patent well-epithelialized lumen was achieved in 11 cases with a follow-up of 3-24 months. Complications were encountered in five cases: three misplaced stents, one tracheal erosion with a Dumon stent and one granulomatous obstruction. The technique, complications and follow-up of these patients are described with recommendations for the management of such patients.
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Affiliation(s)
- Badr Eldin Mostafa
- Department of Otolaryngology and Head and Neck Surgery, Ain-Shams University, Cairo, Egypt.
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26
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Gaissert HA, Grillo HC, Wright CD, Donahue DM, Wain JC, Mathisen DJ. Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 2003; 126:744-7. [PMID: 14502148 DOI: 10.1016/s0022-5223(03)00361-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Self-expanding metal stents are used to palliate benign strictures. We examined the complications of this approach. METHODS Between 1997 and 2002, we observed recurrent airway obstruction and extension of benign inflammatory strictures after the placement of tracheobronchial Microvasive Ultraflex stents and Wallstents (Boston Scientific Corp, Natick, Mass), in 10 patients with postintubation strictures and 5 with other indications; all but 1 patient were referred to us. Patients with tracheal (9), subglottic (1), combined tracheal and subglottic (3), and bronchial (2) strictures had been treated with covered and uncovered Wallstents (6) and Microvasive Ultraflex stents (9). RESULTS After stent insertion, stricture and granulations within previously normal airway were seen in all patients. New subglottic strictures resulting from the stent caused hoarseness in 4 patients. A bronchoesophageal fistula was found in 1 patient at presentation and a tracheoesophageal fistula in another during extraction of a Wallstent. Primary surgical reconstruction, judged to have been feasible before wire stent insertion in 10 patients, was possible after stenting in only 7 and failed in 2. Palliative tubes were placed in 60% (9/15). Self-expanding metal stents may lengthen luminal damage, incite subglottic strictures, and cause esophagorespiratory fistula in inflammatory airway strictures. The injury is severe, occurs after a short duration of stenting, and precludes definitive surgical treatment or requires more extensive tracheal resection. CONCLUSION The current generation of self-expanding metal stents should be avoided in benign strictures of trachea and bronchi.
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Affiliation(s)
- Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Blake 1570, Fruit Street, Boston, MA 02114, USA.
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Abstract
PURPOSE OF REVIEW To familiarize anesthesiologists with recent advances in endoscopic pulmonary stenting. These interventions have replaced surgical procedures for the relief of central airway obstructions. RECENT FINDINGS A pulmonary stent can provide immediate relief of symptoms and improvement in pulmonary function for both intrinsic and extrinsic airway lesions. The current indications for the use of both silicone-rubber stents and expandable metal stents are reviewed. Considerations for the anesthetic management of patients undergoing pulmonary stent placement are also discussed. SUMMARY Tracheo-bronchial stenting procedures are being employed with increasing frequency. The practicing anesthesiologist must be familiar with the management of patients undergoing airway stenting procedures.
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Affiliation(s)
- Jay B Brodsky
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA.
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Wan IYP, Lee TW, Lam HCK, Abdullah V, Yim APC. Tracheobronchial stenting for tuberculous airway stenosis. Chest 2002; 122:370-4. [PMID: 12114385 DOI: 10.1378/chest.122.1.370] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We reviewed the results of the use of the Dumon silicone stents in patients experiencing tuberculous tracheobronchial stenosis since 1994, using a retrospective case review in a university teaching hospital with 1,450 beds serving a population of > 1.8 million. Between February 1994 and September 2001, seven patients with tuberculous tracheobronchial stenosis (mean age, 43 years) underwent a total of 11 dilatations with placement of 10 straight stents and 1 Y stent. Under general anesthesia, all patients underwent rigid bronchoscopy and dilatation of the stenosis with placement of a Dumon stent. There were no deaths. One patient developed a pneumothorax. Two patients experienced migration of the stent, which required reintervention for adjustment of position of the stent. The stents were left in situ for a mean period of 32 months. There was marked improvement in dyspnea in all patients after the procedure, as determined by visual analog scale. Endoscopic dilatation with placement of a silicone stent is an effective treatment for patients with tuberculous tracheobronchial stenosis.
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Affiliation(s)
- Innes Y P Wan
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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30
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Affiliation(s)
- Joseph L Miller
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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