CONCURRENT INSERTION AND INTERNAL FIXATION OF SELF-EXPANDABLE METALLIC STENT (SEMS) IN PROXIMAL TRACHEAL STENOSIS IN HIGH-RISK PATIENTS

Abstract

TYPE: Abstract Publication TOPIC: Procedures PURPOSE: The concurrent stent insertion and fixation should be considered in patients with complex proximal tracheal lesions with a high risk of stent migration. METHODS: Case 1: Female patient 88 years old, with tracheal stenosis due to compression by mediastinal Non-Hodgins lymphoma. SEMS tracheal stent was inserted. Concurrently internal fixation was done to prevent its migration due to the presence of complex stenosis. Revelation after chemotherapy, the suture and the stent were removed. Case 2: Female Patient, 66 years old presented with proximal tracheal compression by esophageal adenocarcinoma. During the balloon dilatation after stent insertion, it was dislocated distally twice. After stent pulling up, the internal suturing of the stent was performed. RESULTS: No results (case report). CONCLUSIONS: The concurrent stent insertion and fixation were associated with satisfying clinical and bronchoscopic results. It should be considered in selected patients with complex tracheal lesions and high risk of stent migration. When indicated, both suture and stent could be easily removed. CLINICAL IMPLICATIONS: We performed an internal fixation of SEMS using a simple intratracheal suture to fix the proximal end of the stent to the posterior wall of the trachea. The thinner wall of SEMS and lower force needed to penetrate the fenestrated metal stent with the suture needle is easier in comparison to the silicon one. The prophylactic fixation aimed to avoid stent migration either due to high risk of migration or observed instability of the stent. The internal fixation overcomes the drawbacks of the external fixation including puncture of neck and trachea, skin maceration, and swallowing discomfort. DISCLOSURE: No significant relationships. KEYWORDS: stent migration, internal fixation, Tracheal stenosis