Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle - a perspective on a new tool to avoid stent migration of Dumon stents

Tracheal fistula repair with stent placement after failure of reconstruction with muscle tissue. A lung cancer surgery complication

A report a case of a 63 year old male diagnosed with lung cancer adenocarcinoma. The patient had a right paratracheal mass diagnosed with EBUS-TBNA 22G. The patient had surgery, however 7 days after the billau catheter was removed pneumothorax was diagnosed which did not resolved. Bronchoscopy reveled two minor fistulas in the interior wall of the trachea. An additional surgery was performed in order to add muscle patches on the exterior part of the trachea. Unfortunately additional stent placement was placed after a silicon stent since the muscle patches failed. We chose a metallic auto expandable stent since after three months of follow up a small metastatic lesion was observed in the liver. Stent placement is an option for these patients and the right stent has to be placed for each case.

Internal fixation of the proximal tracheal self-expandable metallic stent (SEMS): migration prevention in high risk patients

Airway stenting provides an important treatment option for patients with proximal tracheal stenosis. However, the risk of migration remains a major challenging problem. In our report we describe the internal fixation of SEMS in 3 patients with proximal tracheal stenosis due to variable causes. The fixation was performed in different situations including: prophylaxis to prevent the stent migration, fixation due to displacement of the stent during insertion and finally internal fixation of migrated tracheal stent.

A novel simple external fixation for securing silicone stent in patients with upper tracheal stenosis

Upper tracheal stenosis is considered as a potentially life-threatening condition. Silicone stenting is an attractive treatment option for patients with upper tracheal stenosis. However, its use has been compromised by a major complication, stent migration. In the report, we introduced a novel external fixation of silicone stent which only needed one puncture site and involved a silicon chip as an anchoring device. All equipment and materials including the silicon chip were available in routine bronchoscopy suite. The method had been successfully performed in three patients with upper tracheal stenosis at our institution. And the patients were monitored for over 20 months after the intervention, and no spontaneous stent migration occurred. Therefore, we believe this is a simple and reliable approach for improving the outcome of silicone stenting in patients with upper tracheal stenosis and should be introduced in clinical practice.

Computational fluid dynamics evaluation of excessive dynamic airway collapse

BACKGROUND

Excessive dynamic airway collapse, which is often caused by the collapse of the posterior membrane wall during exhalation, is often misdiagnosed with other diseases; stents can provide support for the collapsing airways. The standard pulmonary function tests do not necessarily show change in functional breathing condition for evaluation of these type of diseases.

METHODS

Flow characteristics through a patient's airways with excessive dynamic airway collapse have been numerically investigated. A stent was placed to support the collapsing airway and to improve breathing conditions. Computed tomography images of the patient's pre- and post-stenting were used for generating 3-Dimensional models of the airways, and were imported into a computational fluid dynamics software for simulation of realistic air flow behavior. Unsteady simulations of the inspiratory phase and expiratory phase were performed with patient-specific boundary conditions for pre- and post-intervention cases to investigate the effect of stent placement on flow characteristic and possible improvements.

FINDINGS

Results of post-stent condition show reduced pressure, velocity magnitude and wall shear stress during expiration. The variation in wall shear stress, velocity magnitude and pressure drop is negligible during inspiration.

INTERPRETATION

Although Spirometry tests do not show significant improvements, computational fluid dynamics results show significant improvements in pre- and post-treatment results, suggesting improvement in breathing condition.

A new mode of ventilation for interventional pulmonology. A case with EBUS-TBNA and debulking

Lung cancer is still underdiagnosed mainly due to lack of symptoms. Most patients are diagnosed in a late stage where unfortunately only systematic therapy can be applied. Fortunately in the last five years several novel therapies and combinations have emerged. However; in certain situations local therapeutics modalities have to be applied in order to solve emergency problems as in the case that we will present. Convex-EBUS probe was used along with a novel method of ventilation which keeps PCO₂ concentration satisfyingly low.

Innovative use of a Montgomery cannula in the bronchoscopic management of tracheal stenosis and failed tracheostomy decannulation

Background

Endoprosthesis are being used in the everyday clinical practice either as a permanent solution or transient. They can be used in both benign and malignant situations.

Case presentation

We report a case in which a temporary Montgomery cannula is used in conjunction with therapeutic bronchoscopy to manage a patient with failed tracheostomy decannulation secondary to a distal complex tracheal stenosis.

Conclusions

This innovative use of the Montgomery cannula allowed for successful management of the patient's tracheal stenosis and subsequent tracheostomy tube decannulation.

A retrograde y-stenting of the trachea for treatment of mediastinal fistula in an unusual situation

INTRODUCTION

Stents have been used for quite some time for the treatment of benign and malignant airway stenosis. Silicon stents are preferred for benign situations, whereas metallic self-expanding stents are preferred for malignant comorbidities.

PATIENT AND METHODS

In general, stents can be placed in different approach directions, although in pulmonary medicine it is logical to apply only antegrade techniques - until now. A 63-year-old patient, 168 cm height and 53 kg weight on referral, suffered chronical diseases. The patient was diagnosed with a papillary thyroid carcinoma in 1989, which was treated by resection and radiotherapy. In the following years, she developed a stenosis of the esophagus. The decision to try endobronchial stenting was made upon the plan to close that fistula with a pedicled omentum majus replacement through the diaphragmal opening of the esophagus. This surgical plastic needed an abutment and a secured continuous airway replacement above the tracheostoma level. A Freitag stent (FS), 11 cm in length (110-25-40) and an inner diameter of 13 mm, was placed successfully retrograde into the trachea and completely bridged the big fistula. Unfortunately the patient passed away due to pulmonary infections after several weeks.

DISCUSSION

In this case report, a successful but unusual case of retrograde stent placement of a modified FS is presented.

Benign tracheal stenosis a case report and up to date management

Benign tracheal stenosis is situation that occurs usually after stress is applied to a certain area in the trachea during the intubation of a patient or inflammation caused during an infection. In the current case report we will present a 65-year-old man with a benign tracheal stenosis due to a 15-day intubation with a high pressure and low volume intubation tube. Current methodology was applied in his case with an excellent result with a 1-year follow up. Cryotherapy, electrocautery-knife, balloon dilation and semi-rigid bronchoscopic technique were applied. Currently there are several techniques that can be used by pulmonary physicians or ear, nose and throat experts. It remains for the treating physician to choose its method based on his training, equipment and tissue damage.

Survival and Quality of Life Benefit after Endoscopic Management of Malignant Central Airway Obstruction

Background: Although interventional management of malignant central airway obstruction (mCAO) is well established, its impact on survival and quality of life (QoL) has not been extensively studied.

Aim: We prospectively assessed survival, QoL and dyspnea (using validated EORTC questionnaire) in patients with mCAO 1 day before interventional bronchoscopy, 1 week after and every following month, in comparison to patients who declined this approach.

Material/Patients/Methods: 36 patients underwent extensive interventional bronchoscopic management as indicated, whereas 12 declined. All patients received full chemotherapy and radiotherapy as indicated. Patients of the 2 groups were matched for age, comorbidities, type of malignancy and level of obstruction. Follow up time was 8.0±8.7 (range 1-38) months.

Results: Mean survival for intervention and control group was 10±9 and 4±3 months respectively (p=0.04). QoL improved significantly in intervention group patients up to the 6^th month (p<0.05) not deteriorating for those surviving up to 12 months. Dyspnea decreased in patients of the intervention group 1 month post procedure remaining reduced for survivors over the 12th month. Patients of the control group had worse QoL and dyspnea in all time points.

Conclusions: Interventional management of patients with mCAO, may achieve prolonged survival with sustained significant improvement of QoL and dyspnea.

Drug Eluting Stents for Malignant Airway Obstruction: A Critical Review of the Literature

Lung cancer being the most prevalent malignancy in men and the 3(rd) most frequent in women is still associated with dismal prognosis due to advanced disease at the time of diagnosis. Novel targeted therapies are already on the market and several others are under investigation. However non-specific cytotoxic agents still remain the cornerstone of treatment for many patients. Central airways stenosis or obstruction may often complicate and decrease quality of life and survival of these patients. Interventional pulmonology modalities (mainly debulking and stent placement) can alleviate symptoms related to airways stenosis and improve the quality of life of patients. Mitomycin C and sirolimus have been observed to assist a successful stent placement by reducing granuloma tissue formation. Additionally, these drugs enhance the normal tissue ability against cancer cell infiltration. In this mini review we will concentrate on mitomycin C and sirolimus and their use in stent placement.