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Aravena C, Gildea TR. Advancements in airway stents: a comprehensive update. Curr Opin Pulm Med 2024; 30:75-83. [PMID: 37937587 DOI: 10.1097/mcp.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It discusses recent advancements, including 3D-printed silicone stents (3DPSS), metallic stents, biodegradable stents (BS), and drug-eluting stents (DES), which are transforming clinical practice. The review underscores the ongoing challenges in patient selection, stent choice, and long-term management in the context of an evolving landscape. RECENT FINDINGS Innovations, particularly 3DPSS, have shown promise in providing patient-specific solutions. These stents offer improved symptom relief, enhanced quality of life, and lower complication rates, especially for complex airway diseases. The use of BS and DES is explored, raising prospects for future applications. SUMMARY The evolution of AS reflects a deepening understanding of airway obstructions. Recent innovations, such as 3DPSS, BS, and DES, show considerable promise in addressing the limitations of conventional stents. However, challenges related to complications, patient selection, and long-term management persist, demanding further research. Wide practice variations in the management of AS highlight the need for more clinical data and standardized guidelines. The search for the ideal stent continues, driven by the pursuit of better outcomes for patients with CAO.
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Affiliation(s)
- Carlos Aravena
- Department of Respiratory Diseases, Faculty of Medicine, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Thomas R Gildea
- Respiratory Institute. Pulmonary, Allergy and Critical care Medicine and Transplant Center, Cleveland Clinic. Cleveland, Ohio, USA
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2
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Bashour SI, Ost DE. An update on bronchopleural fistulae following cancer-related surgery. Curr Opin Pulm Med 2023; 29:223-231. [PMID: 37102602 DOI: 10.1097/mcp.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE OF REVIEW Bronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity. RECENT FINDINGS Multiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection. SUMMARY Management of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.
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Affiliation(s)
- Sami I Bashour
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Zhao P. Progress Report on Interventional Treatment for Bronchopleural Fistula. Emerg Med Int 2023; 2023:8615055. [PMID: 37398639 PMCID: PMC10310459 DOI: 10.1155/2023/8615055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives Bronchopleural fistula (BPF) is a serious and life-threatening complication. Following the advent of interventional radiology, subsequent treatment methods for BPF have gradually diversified. Therefore, this article provides an overview of the present scenario of interventional treatment and research advancements pertaining to BPF. Methods Relevant published studies on the interventional treatment of BPF were identified from the PubMed, Sci-Hub, Google Scholar, CNKI, VIP, and Wanfang databases. The included studies better reflect the current status of and progress in interventional treatments for BPF with representativeness, reliability, and timeliness. Studies with similar and repetitive conclusions were excluded. Results There are many different interventional treatments for BPF that can be applied in cases of BPF with different fistula diameters. Conclusion The application of interventional procedures for bronchopleural fistula has proven to be safe, efficacious, and minimally invasive. However, the establishment of comprehensive, standardized treatment guidelines necessitates further pertinent research to attain consensus within the medical community. The evolution of novel technologies, tools, techniques, and materials specifically tailored to the interventional management of bronchopleural fistula is anticipated to be the focal point of forthcoming investigations. These advancements present promising prospects for seamless translation into clinical practice and application, thereby potentially revolutionizing patient care in this field.
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Affiliation(s)
- Pei Zhao
- The Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
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Roy P, Héluain V, Leyx P, Villeneuve T, Vergé R, Brouchet L, Guibert N. A 3D-engineered silicone stent to treat a refractory bronchopleural fistula. ERJ Open Res 2023; 9:00670-2022. [PMID: 36923567 PMCID: PMC10009704 DOI: 10.1183/23120541.00670-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/29/2022] [Indexed: 03/11/2023] Open
Abstract
A novel 3D-engineered silicone stent was successfully used to treat a refractory bronchopleural fistula of the right lower lobe in a patient with an open-window thoracostomy who complained of severe dysphonia and recurrent infections https://bit.ly/3GrKs2p.
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Affiliation(s)
- Pascalin Roy
- Pulmonology Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France.,Department of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Canada
| | - Valentin Héluain
- Pulmonology Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France
| | | | - Thomas Villeneuve
- Pulmonology Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France
| | - Romain Vergé
- Thoracic Surgery Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France
| | - Laurent Brouchet
- Thoracic Surgery Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France.,University of Toulouse III (Paul Sabatier), Toulouse, France
| | - Nicolas Guibert
- Pulmonology Department, Larrey Hospital, University Hospital of Toulouse, Toulouse, France.,University of Toulouse III (Paul Sabatier), Toulouse, France
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Gutte AA, Dembla S. Endobronchial management of bronchopleural fistula using vascular plug device—a case report. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bronchopleural fistula (BPF) is a sinus tract between the pleural space and the main stem, lobar, or segmental bronchus. The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. An interdisciplinary approach, early diagnosis, and timely management of these lesions are critical in the management of such lesions.
Case presentation
We describe a case of bronchopleural fistula in a 42-year-old female patient, occurring after a surgery for pulmonary hydatid, which was successfully managed using a minimally invasive method of closure using Amplatzer vascular plug (AVP).
To our knowledge, the use of an AVP for the management of a BPF following hydatid cyst marsupialization has rarely been described in the past.
Conclusion
AVP is a useful device in the management of bronchopleural fistulas, especially in patients failing a trial of conservative management and are high-risk candidates for surgeries.
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Wang F, Li Z, Lyu FJ, Gao J, Lin J, Liu J, Chen X, Li Z, Shan J, Wu J. The therapeutic effect of stem cells from human exfoliated deciduous teeth on a rat model of tracheal fistula. Stem Cell Res Ther 2022; 13:310. [PMID: 35841116 PMCID: PMC9284811 DOI: 10.1186/s13287-022-02994-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background Tracheal fistulas (TF) can be dangerous and even fatal in patients. The current treatment is really challenging. Previous studies reported that mesenchymal stem cells (MSCs) could be used to treat respiratory tract fistulas. Stem cells from human exfoliated deciduous teeth (SHED) are considered to be MSC-like cells that may also have the potential to treat the tracheal fistulas. In this study, we investigated the therapeutic effects of SHED in rat tracheal fistula models. Methods A total of 80 SD rats were randomly divided into five groups: a sham-operated group, a local PBS group (L-PBS), an intravenous PBS group (I-PBS), a local SHED treatment group (L-SHED), and an intravenous SHED treatment group (I-SHED). The L-SHED and I-SHED groups were given a topical application around the fistula or an intravenous injection of 1*107 SHED via the tail vein, respectively, while the L-PBS and I-PBS groups were given an equivalent volume of PBS through local or intravenous administration. A stereomicroscope was used to observe fistula healing on the 2nd, 3rd, and 5th days following transplantation. On the 7th day, the survival of SHED was observed by immunofluorescence. The pathology of the lungs and fistulas was observed by hematoxylin and eosin (H&E) and Masson staining. The expression levels of the Toll-like receptor 4 (TLR4), interleukin (IL)-1β, IL-33, and IL-4 were measured using immunohistochemistry. The expression levels of TLR4, high mobility group box 1 (HMGB1), and myeloid differentiation factor 88 (MYD88) were studied using western blotting. On day 14, airway responsiveness of rats was detected and analyzed. Results Fistula healing in the L-SHED and I-SHED groups was faster than that in their respective PBS groups after transplantation. The fistula diameters in the L-SHED and I-SHED groups were significantly smaller than those in the L-PBS and I-PBS groups on the 3rd day. Moreover, the phenomenon of fibroblast proliferation and new blood vessel growth around the fistula seemed more pronounced in the L-SHED and I-SHED groups. Although no discernible difference was found in airway responsiveness after SHED treatment, the degree of inflammation in the lungs was reduced by intravenous SHED treatment. However, there was no significant reduction in lung inflammation by local SHED treatment. The expression levels of IL-1β and IL-33 were decreased in the I-SHED group, while IL-4 was elevated compared with the I-PBS group. Interestingly, intravenous SHED treatment inhibited the activation of HMGB1/TLR4/MYD88 in the lung tissues of TF rats. Conclusions SHED transplantation accelerated the rate of fistula healing in rats. Intravenous SHED treatment reduced lung inflammation. Thus, SHED may have potential in the treatment of tracheal fistula, providing hope for future therapeutic development for TF.
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Affiliation(s)
- Fang Wang
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.,Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Zhangwen Li
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.,Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng-Juan Lyu
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Jie Gao
- Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Jinle Lin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.,Department of Emergency Medicine, Affiliated Baoan Hospital of Shenzhen, The second school of clinical medicine, Southern Medical University, Shenzhen, 518101, China
| | - Jianling Liu
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.,Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Xiaowen Chen
- School of Medicine, South China University of Technology, Guangzhou, 510006, China.,Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Zhongpeng Li
- Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Jiajie Shan
- School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Jian Wu
- School of Medicine, South China University of Technology, Guangzhou, 510006, China. .,Second Department of Elderly Respiratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.
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