AB 63. Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea
Abstract

AB 63. Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea

Kosmas Tsakiridis1, Kaid Darwiche2, Aikaterini N. Visouli1, Paul Zarogoulidis3, Nikolaos Machairiotis4, Christos Christofis5, Aikaterini Stylianaki4, Nikolaos Katsikogiannis4, Andreas Mpakas6, Nicolaos Courcoutsakis7, Konstantinos Zarogoulidis3

1Cardiothoracic Department, St Luke’s Hospital, Panorama, Thessaloniki, Greece; 2University Pulmonary Department- Interventional Unit, “Ruhrland” Clinic, University of Duisburg- Essen, Essen, Germany; 3Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 4Surgery Department (NHS), University General Hospital of Alexandroupolis, Alexandroupolis, Greece; 5Anesthisiology Department, University General Hospital of Alexandroupolis, Alexandroupolis, Greece; 6Cardiothoracic Department, St Luke’s Hospital, Panorama, Thessaloniki, Greece; 7Radiology Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece

Background: Tracheal stenosis is a potentially life-threatening condition. Tracheostomy and endotracheal intubation remain the commonest causes of benign stenosis, despite improvements in design and management of tubes. Post-tracheostomy stenosis is more frequently encountered due to earlier performance of tracheostomy in intensive care units, while the incidence of post-intubation stenosis has decreased with application of highvolume low-pressure cuffs. We present tracheal stenting in complex posttracheostomy stenoses.

Patients and methods: We inserted tracheal silicone stents (Dumon) under general anaesthesia through rigid bronchoscopy in two patients with benign post-tracheostomy stenoses: a 39-year old woman treated for acute respiratory failure (dyspnoea, hemoptysis, alveolar bleeding, attributed to seronegative lung vasculitis) who initially underwent surgical resection and end-to-end anastomosis, but developed restenosis (anastomotic granulation/scarring), and suffered continuous relapses after multiple bronchoscopic interventions, underwent silicone stenting (length 4.5 cm, diameter 12 mm). A 20-year old man treated for severe head trauma after a car accident developed a long tracheal stricture involving the subglottic larynx (lower posterior part), having inflamed tracheostomy site tissues (positive for methicillin resistant staphylococcus aureus), underwent silicone stenting (length 7 cm, diameter 14 mm).

Results: The airway was immediately re-establish, without complications (tracheal rupture/pneumomediastinum, bleeding). At 15 and 10 months follow-up (respectively) there was no stent migration, luminal patency was maintained without: adjacent structure erosion, secretion adherence inside the stents, granulation at the ends. Tracheostomy tissue inflammation was resolved (2nd patient), new infection was not noted. The patients maintain good respiratory function and will be evaluated for scheduled stent removal.

Conclusions: In symptomatic benign tracheal stenosis the gold standard is surgical reconstruction (often after interventional bronchoscopy). Stenting is reserved for symptomatic tracheal narrowing deemed inoperable due to local or general reasons: inflammation, long strictures, previous failed operation, poor respiratory, cardiac or neurological status. When stenting is decided, silicone stent insertion is considered treatment of choice in the presence of inflammation and/or when removal is desirable. Silicone stents are removable, resistant to microbial colonization and are associated with minimal granulation. In benign post-tracheostomy stenosis silicone stenting was safe and effective in re-stenosis after surgery and multiple bronchoscopic interventions, and in long stenosis in the presence on inflammation and poor neurological status.

Cite this abstract as: Tsakiridis K, Visouli AN, Zarogoulidis P, Machairiotis N, Christofis C, Stylianaki A, Katsikogiannis N, Mpakas A, Courcoutsakis N, Zarogoulidis K. Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea. J Thorac Dis 2012;4(S1):AB63. DOI: 10.3978/j.issn.2072-1439.2012.s063

Article Options

Download Citation

Share