Bronchial Stent Research Articles

Lethal Complication of Postairway Stenting to Trachea and Left Main Bronchus: A Case Series with Discussion of the Diagnosis and Management

Abstract The insertion of a metallic airway stent is a valuable method for the treatment of benign and malignant airway stenosis and tracheoesophageal fistula. Although stenting for airway stenosis has become widely popular with favorable outcomes, several complications can arise after stenting, such as migration, tendency for stent fracture, and ingrowth of tumor or granulation tissue into the stent. Very few of these reports have described the complications of poststenting pneumothorax. We report the cases of three patients diagnosed with squamous cell carcinoma of the esophagus, complicated by tracheoesophageal fistula, and treated with a tracheal stent or bronchial stent, who developed poststenting pneumothorax.

Pulmonary Artery Endograft Implantation Using a Parallel Stent Grafting Technique to Enable the Treatment of a Bronchial Anastomosis Complication After Lung Transplantation.

Bronchial stenosis associated with bronchial anastomosis dehiscence after lung transplantation is a catastrophic complication following lung transplantation with a paucity of therapeutic solutions. To describe an adaptation of the parallel stent grafting technique in the pulmonary arterial territory to treat this challenging situation. This is a case report of a 52-year-old patient who presented bronchus stenosis and bronchial anastomosis dehiscence after lung transplantion. Bronchial stenting and lung retransplantation were contraindicated. Therefore, an endovascular approach using pulmonary artery endograft placement to prevent bleeding during repeated right bronchial balloon dilation was propposed. The technique consists of the deployment of an aortic extender endoprosthesis in the right main pulmonary artery and a balloon expandable stent in the upper lobe pulmonary artery (using a parallel graft configuration) through the common femoral and right internal jugular veins, respectively. Intraoperative transesophageal echocardiogram and one-lung ventilatory ventilation are needed. The patient underwent a new bronchoscopy 16 days after the procedure, that showed epithelization at the previous eroded zone, enabling bronchocopic balloon dialtion to be safely performed. A post-operative contrast-enhanced CT scan revealed an adequate positioning of the stent grafts. Despite all eforts, the patient succumbed to ventilator associated pneumonia on postoperative day 108. The technique's advantages include its feasibility even in situations in which other techniques may be contraindicated and its potential use in emergencies. Its limitations include the need for experienced interventionists to perform it, and the potential risk of acute tricuspid regurgitation. This study illustrates the early feasibility of the parallel stent grafting technique applied to the pulmonary artery territory. However, it's safety profile regarding infectious risk was not demontrated.

The safety and effectiveness of the treatment of refractory post-intubation subglottic stenosis using short bronchial Dumon stent: a pilot study.

Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

Corrigendum to ‘‘Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report”

Corrigendum to ‘‘Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report”

Fabrication of a 3D printed everolimus-eluting stent made of thermoplastic polyurethane and polylactide

Bronchial stenoses are one of the most common airways complications after lung transplantation. One of the main methods to restore airway patency is bronchial stenting. However, bronchial stenting is associated with a number of complications, such as stent migration, granulation tissue formation along the proximal and distal edges, and mucus obstruction of the lumen. This article demonstrates the possibility of manufacturing an everolimus-eluting stent from thermoplastic polyurethane and polylactide using 3D printing.

Treatment of Esophago-Airway Fistula after Esophageal Resection.

(1) Background: Esophago-airway fistula after esophageal resection is a rare, life-threatening complication associated with a high postoperative mortality rate. Managing this condition is challenging, and the prognosis for patients is uncertain. The results and our own approach to treatment are presented. (2) Material and Methods: We present a retrospective analysis of a group of 22 patients treated for an esophago-airway fistula between 2012 and 2022, with 21 cases after esophageal resection and one during the course of Hodgkin's disease. (3) Results: Twenty-two patients were treated for an esophago-airway fistula. Among them, a tracheobronchial fistula occurred in 21 (95.4%) patients during the postoperative period, while 1 (4.5%) was treated for Hodgkin's disease. Of these cases, 17 (70.7%) patients underwent esophageal diversion with various treatments, including intercostal flap in most cases, greater omentum in one (4.5%), latissimus dorsi muscle in two (9%), and greater pectoral muscle in one (4.5%). Esophageal stenting was performed in two patients (9.0%), and one (4.5%) was treated conservatively. Unfortunately, one patient (4.5%) died after being treated with bronchial stenting, and two (9.5%) experienced a recurrence of the fistula. (4) Conclusions: The occurrence of an esophago-airway fistula after esophagectomy is a rare but life-threatening complication with an uncertain prognosis that results in several serious perioperative sequelae.

Phage Therapy in Lung Transplantation: Current Status and Future Possibilities.

Patients with chronic lung disease and lung transplantation have high rates of colonization and infection from multidrug-resistant (MDR) organisms. This article summarizes the current state of knowledge regarding phage therapy in the setting of lung transplantation. Phage therapy has been used in several lung transplant candidates and recipients on a compassionate use basis targeting mostly MDR gram-negative infections and atypical mycobacterial infections with demonstrated clinical safety. Phage biodistribution given intravenously or via nebulization has not been extensively studied, though preliminary data are presented. Phage interacts with both the innate and adaptive immune system; current literature demonstrates the development of serum neutralization in some cases of phage therapy, although the clinical impact seems variable. A summary of current clinical trials involving patients with chronic lung disease is presented, though none are specifically targeting lung transplant candidates or recipients. In addition to treatment of active infections, a variety of clinical scenarios may benefit from phage therapy, and well-designed clinical trials involving this vulnerable patient population are needed: pre- or peritransplantation use of phage in the setting of MDR organism colonization may lead to waitlisting of candidates currently declined by many centers, along with potential reduction of waitlist mortality rates and posttransplant infections; phage may be used for biofilm-related bronchial stent infections; and, finally, there is a possibility that phage use can affect allograft function and chronic rejection.

Clinical Cases of Successful Endoscopic Bronchial Stenting

Introduction. A comprehensive approach to restore the patency of the trachea and bronchi in stenoses of various origin consists in their endoscopic stenting, which can be both temporary and maximum continuous.Materials and methods. The study presents two clinical cases of successful endoscopic stenting of the lower lobar bronchi of the lungs with relief of respiratory failure. In the first case, the left inferior lobar bronchus was compressed from the outside by a hematoma from a ruptured false aortic aneurysm. Thus, the aneurysm was stented first, and the compressed bronchus — second. In the second case, the right inferior lobar bronchus was stented due to lung metastases. In both cases, bronchial stenosis was accompanied by pulmonary atelectasis.Results and discussion. In both cases, stenting was effective in restoring the patency of stenosed bronchi and expanding the lungs, which enabled respiratory failure to be stopped. In the first case, 3 months after the stenting, its outward migration was revealed, but no recurrence of bronchial narrowing was observed during further dynamic observation. In the second case, the follow-up of the patient for 6 months after stenting showed adequate functioning of the stent.Conclusion. The presented clinical cases demonstrate high efficacy and reliability of endoscopic stenting in bronchial stenoses of various origin to cope with the respiratory failure and thereby improve the quality of life.

Bronchial collapse and bronchial stenting in 9 dogs.

Principal and lobar bronchial collapse is increasingly recognized as an isolated entity. Retrospectively describe the procedure and outcomes of dogs undergoing bronchial stenting at a single referral hospital. Nine client-owned dogs with variable degrees of collapse of the left principal bronchus (LPB), lobar bronchus 1 (LB1), and lobar bronchus 2 (LB2), and with clinically relevant signs of respiratory dysfunction. Data were collected from patient records. All dogs underwent stenting of the LPB and LB2. Anatomic and functional impairment grades were assigned to each case before and 4 weeks after stenting. Data regarding response to stenting and complications were evaluated. Bronchial stenting was considered successful in all cases, with all dogs experiencing improved quality of life (QOL), and decreased functional impairment grade at 4 weeks post-stenting. Follow-up of >6 months was available for 6 dogs and of these, 5 were alive at 12 months, 3 were alive at 18 months, and 1 was alive at 24 months. Stent-related complications occurred in 4 dogs, and were resolvable in 3. Two dogs developed pneumothorax, 1 developed recurrent pneumonia, and 1 developed new-onset coughing. All dogs had mild and manageable coughing post-stenting. Stenting of the LBP and LB2 might be an effective option for dogs with advanced collapse of these bronchi and associated signs. Although all included dogs had resolution or improvement of clinical signs considered life-threatening or as affecting QOL, ongoing coughing is expected. Patient selection appears important with regard to achieving successful outcomes.

Alleviation of malignant dysphagia in inoperable lung cancer.

Due to the close anatomical relationship between the esophagus and the bronchial tree, lung cancer can cause malignant dysphagia. Patients with this complication may require palliation through esophageal and/or bronchial tree restoration. Between the years 2008 and 2018, malignant dysphagia was diagnosed in 84 lung cancer patients. Their response to esophageal and/or bronchial tree stenting was studied retrospectively. Patients were stratified into three groups: esophageal compression without obstruction of the bronchi (Group I, n=64), esophageal compression and bronchial obstruction without fistulas (Group II, n=12), and dysphagia and esophagotracheal fistula (Group III, n=8). Group I had one stent implanted, whilst in Groups II and III, two stents were introduced. Both self-expanding stents and silicone Y stents were utilized. Prior to intervention and during the follow-up period, patients were assessed for degree of dysphagia and dyspnea, quality of life, and survival. Following endoprosthetic restoration, dysphagia score improved in all patient groups with reductions in Group I (2.68 vs. 1.2, P=0.0001), in Group II (2.76 vs. 1.3, P=0.0001), and in Group III (2.74 vs. 1.3, P=0.0001). There was no dyspnea recorded in Group I before an intervention, however it was present and reduced in Group II (2.86 vs. 0.4, P=0.001) and Group III (2.89 vs. 0.5, P=0.0001) following intervention. Quality of life was improved for all patient groups, with an increase in Karnofsky performance scale in Group I (56 vs. 72, P=0.0001), Group II (56 vs. 70, P=0.0001) and Group III (53 vs. 67, P=0.0001). Three patients (3.6%) developed respiratory failure and 1 patient (0.8%) died. Two patients (2.4%), following esophageal stenting, required bronchial tree stenting. Dysphagia occurred in 5 patients (6.0%) due to granuloma formation. In these cases, the stents were removed and re-stenting was carried out. In 3 of the patients (3.6%) the stents were removed due to migration and re-stenting was performed. Patients with malignant dysphagia due to lung cancer may require esophageal stenting as well as bronchial tree stenting. This treatment offers improvements in dysphagia and dyspnea scores, as well as in quality of life, and allows for the implementation of oncological treatments.

Anastomotic complications after lung transplantation

: Anastomotic complications following lung transplantation include those affecting one of the three anastomoses performed in the usual technique for lung transplantation: the bronchial, the pulmonary artery, and the pulmonary venous anastomoses. Airway complications have declined over time, but still are associated with significant morbidity and mortality. The main pathogenic factor associated to the development of airway complications is the post-transplant bronchial ischemia. The most frequent anastomotic airway complication is bronchial stenosis. Other complications include bronchial dehiscence, granulation tissue formation, bronchomalacia, and bronchial fistulae. The main diagnostic tools for diagnosis of such complications are imaging techniques such as chest computed tomography (CT) scan and bronchoscopic examination, which allows an appropriate assessment of the bronchial mucosa and extent of the airway complication. A combination of several bronchoscopic procedures is usually required to best manage post-transplant airway complications. These include balloon dilatation, cryotherapy, laser resection, electrocautery, endobronchial brachytherapy, and bronchial stenting. On occasion, different surgical approaches are required, including graft resection or re-transplantation. The incidence of vascular anastomotic complications after lung transplantation is low, but they are associated to high morbidity and mortality rates. These complications comprise either the pulmonary artery anastomosis or the venous anastomosis, and stenoses are the most frequently observed. In the pulmonary artery, an excessive length of vascular ends may lead to kinking, vascular torsion, and stenosis. In the venous anastomosis, an improper surgical technique, or an anastomotic intussusception due to excessive lengh leads to the development of thrombosis at the anastomotic site. Early detection and rapid treatment of these complications is crucial for its successful management. Appropriate selection of the best therapeutic option depends on the time of onset of the vascular complication and the expertise of the transplant team. It usually requires a multidisciplinary approach comprising either endovascular procedures or surgical correction.

Coil embolization of a pulmonary artery-bronchial fistula associated with intra parenchymal pseudoaneurysm, endovascular approach, and bronchoscopy monitoring – A case report

A 62-year-old man with a heavy background of the right upper lobe squamous cell carcinoma was admitted with massive hemoptysis. Computerized tomography (CT) showed a large right upper lobe lesion with infiltration of mediastinum and airways. A right pulmonary artery pseudoaneurysm slightly bulging into the right main bronchus was seen, suspicious for a pulmonary artery bronchial fistula. A combined endotracheal and angiographic approach was done. The right pulmonary artery angiogram showed a now occluded neck to the pseudoaneurysm which was selectively cannulated. Framing and packing coils were deployed. Contrast was endoscopically noted without bronchial bleeding. As the coils were entering the lung parenchyma, packing back to the neck was done carefully. No new bleeding was noted. A bronchial stent was inserted 6 weeks later and one coil protruding into the bronchus was seen. A 3 month CT follow-up did not show any residual pseudoaneurysm. Patient died 3 months after initial procedure of his progressive illness. Only three cases of endovascular management of bronchial-pulmonary artery fistula reported with different techniques including pulmonary artery stenting. Our case is the only one reported treated with only coil embolization. Limited data are available regarding the risk of pulmonary embolism after stenting. Anticoagulation required after stenting increases the risk of bleeding in patients with severe hemoptysis. Management with coils only facilitates further management. This preserves pulmonary circulation in patients with already compromised respiratory function. Coil only embolization of uncommon pulmonary artery bronchial fistula is feasible and facilitates further management as it does not require anticoagulation in patient with recurrent bleeding.

Emergency repair of traumatic avulsion of the right main stem bronchus using biliary stent in a 6-year-Old girl: A case report

Pediatric thoracic trauma is a rare condition, but results in high levels of morbidity and mortality. These injuries are often more devastating in the pediatric population due to differences in children's anatomy and physiology relative to adult patients. Tracheobronchial injuries secondary to blunt trauma are difficult to diagnose compared to penetrating trauma. So, a high index of suspicion is of utmost importance. We report a case of a 6-year-old girl who experienced complete avulsion of the right main bronchus. The patient presented with extensive emphysema and severe respiratory distress with bilateral tension pneumothorax. Endotracheal intubation and two thoracostomy tubes were applied. Pneumothorax and a massive air leak persisted on the right side. After thoracotomy, right main bronchus avulsion was present and then repaired by end-to-end anastomosis and muscle flap. minimal air leaks from right chest tubes and partially expanding right lung on chest X-ray are seen after that. So, reinforcement by biliary (instead of bronchial) stent was performed because unavailability of bronchial stent with the desired size at that time. Traumatic tracheobronchial damage occurs in just 0.05-3% of all pediatric thoracic traumas. It's fatal condition especially in first hour. With proper recognition and management of these injuries, there is an associated improved long-term outcome. This article reviews the current literature and discusses the initial evaluation, current management practices, and future directions in pediatric thoracic trauma. Biliary stent placement could be a reasonable treatment option for tracheobronchial damage.

TU1.6 Endoscopic Management of Broncho-Oesophageal Fistula Caused by Impacted Denture

Abstract Background Oesophageal foreign body impaction in adults is fairly common. Although, dentures being often accidentally ingested among the elderly, it is very unusual to develop a broncho-oesophageal fistula (BOF) secondary to a retained denture. The few cases reported in the literature were mostly managed with thoracotomy. We present a clinical case of a BOF successfully treated by endoscopic approach following a combined assessment and planning between intervention radiology, general and cardiothoracic surgery. Case Report A 60-year-old male was transferred from neighbouring DGH to our centre due to worsening of dysphagia. Patient reported that he had swallowed a denture 6 month earlier. The CT scan showed the denture along with a left BOF. Imaging was further reviewed and discussed amongst interventional radiology, cardiothoracic, and upper gastrointestinal surgeons. Endoscopic retrieval of impacted denture plate was successful, followed by the insertion of left bronchial stent, and percutaneous gastrostomy tube. The left bronchial stent was removed after three months with successful closure of the fistula. Conclusion Our clinical case highlights that multidisciplinary team discussion is crucial in the management of complex surgical cases in order to achieve the best outcome possible. Additionally, endoscopic management of BOF is a safe alternative option to thoracotomy when the required resources are available.

Development of Bronchial Stent for High Ciliary Function in Respiratory Tract

A balloon expandable tracheal stent is used to broaden the respiratory system, primarily to avoid tracheal rings from collapsing or causing central airway obstruction (CAO). The research relates to a stent that improves air flow in the "windpipe" or "trachea tract" by limiting the amount of surface area covered by the stent, allowing cilia to function normally. Furthermore, the stent decreases mucus collection and tissue granulation within the stent, which has improved anti-migration properties due to flare ends, is suited for custom size, and reduces the risk of airway perforation and erosion. A therapeutic substance is coated on the stent to avoid infection at the treatment site.

Management of post-operative ventilator dependency in an operated case of tetralogy of Fallot with absent pulmonary valve: a team approach involving cardiac surgeon, cardiologist, intensivist, and radiologist.

Tetralogy of Fallot with absent pulmonary valve syndrome is commonly associated with trachea-bronchial anomalies, possibly due to airway compression caused by massively dilated pulmonary arteries secondary to severe pulmonary regurgitation. This airway obstruction may persist post-operatively also. We report a case of an infant who required a series of management strategies including bronchial stenting to manage his obstructive symptoms.

Airway Complications After Lung Transplant for Post Coronaviral Disease (COVID-19) Acute Respiratory Distress Syndrome (ARDS) Related End Stage Lung Disease: Single Centre Experience

PurposeSevere COVID-19 ARDS related end stage lung fibrosis with irreversible changes is a newer indication for lung transplantation with acceptable survival rate. Airway complication post lung transplant is a major source of morbidity and mortality with incidence as high as 25 to 49 percent. Patients with end stage COVID-19 fibrosis are likely to be clinically deconditioned with long duration of extracorporeal oxygenator (ECMO) support, high burden of sepsis and prolonged respiratory support which may affect the airways post lung transplantation.MethodsThis is a retrospective observational study after obtaining institutional ethical clearance. We reviewed electronic medical data of patients who underwent lung transplantation for post COVID-19 ARDS related fibrosis. We evaluated the incidence and type of airway complications and the various therapeutic interventions applied for its management.ResultsBetween May 2020 and September 2021 our centre performed 23 bilateral lung transplants for end stage COVID-19 ARDS related fibrosis. 22 patients were on ECMO support with mean duration of 50.9 days before transplantation. All patients underwent lung transplantation with central Veno-Arterial ECMO support with mean organ ischaemia time of 360±154 minutes. The incidence of airway complication in our study group was 56%. We observed anastomotic narrowing in 3(13%), distal airway narrowing in 4(17%) and sloughing/coating of anastomotic site in 5(22%) patients. Nonspecific inflammatory polypi around the bronchial anastomotic site were noticed in 4(17%) and mild airway anastomotic dehiscence in 2 subjects. 8(34%) patients required serial bronchoscopy and balloon dilatation; 2 among them mandated additional cautery usage. 2 cases underwent polypectomy, further 4 subjects needed bronchial stent placement. 5 (21%) recipients were discharged with Tracheostomy while rest were successfully decannulated in the ward.ConclusionWe observed a high incidence of airway complications in post lung transplant for COVID-19 ARDS related fibrosis. Early detection, timely management and serial follow up is of paramount importance in this subset of patients.

Bronchial Stent Placement for Palliative Treatment of Pulmonary Carcinoma with Bronchial Obstruction in a Cat.

A feral, domestic shorthair was evaluated for palliative treatment of a pulmonary mass with secondary pneumonia. Because of the patient's temperament and extent of the mass, tracheobronchoscopy, bronchial stenting, and biopsy were elected, followed by adjuvant radiation therapy. Stent placement across the malignantly obstructed bronchus permitted drainage and recruitment of the infected lung lobe. Uncomplicated radiation therapy, stent extension, and debulking due to tissue ingrowth were subsequently performed. Successful palliation was achieved for 323 days with subsequent progressive pulmonary and liver metastases.

Salvage surgery following immuno-chemo-radiotherapy for advanced non-small cell lung cancer

BackgroundSalvage surgery following definitive radiotherapy or systemic treatment has become a feasible treatment option in selected patients with advanced initially unresectable non-small cell lung cancer. Recent clinical trials of neoadjuvant treatment have showed that surgery following immuno-chemotherapy is safely performed. Here, we present the first case of salvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced lung large cell carcinoma.Case presentationA 44-year male was admitted to our hospital for salvage surgery. Ten months prior to this administration, he had been diagnosed with unresectable large cell carcinoma with malignant pericardial effusion (clinical stage IVA/T3N2M1A; no driver-gene alteration) originating from the right upper lobe (RUL). Due to rapid intrabronchial tumor growth causing severe dyspnea, emergency bronchial stenting in the right main bronchus using an expandable metallic stent had been performed. Thereafter, he had received immuno-chemotherapy with concurrent definitive radiotherapy. Despite dramatic radiographic response, he had suffered from persistent and refractory Pseudomonas aeruginosa lung infection associated with bronchial stent placement. As pericardial effusion had disappeared and no distant metastasis had developed, he was diagnosed with a potentially curable disease and was referred to our hospital. An extended sleeve resection was successfully performed, and pathological sections revealed that pathologic complete response was achieved with immuno-chemo-radiotherapy. The patient received no subsequent treatment, and is alive without tumor recurrence at 8 months after surgery.ConclusionsSalvage surgery following immuno-chemotherapy with concurrent definitive radiotherapy for advanced non-small cell lung cancer may be feasible in selected patients, and may be considered as a treatment option to control local disease.

Esophageal Intramural Pseudodiverticulosis and Esophagobronchial Fistula Palliated with Esophageal and Bronchial Stenting: A Rare Case Report

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition characterized by outpouchings from the esophageal lumen into the outer esophageal wall. It can lead to complications such as esophageal strictures presenting as dysphagia and esophagobronchial fistula (EBF) presenting as recurrent aspiration pneumonia. Only 1 other report of EIP with EBF has been reported in the literature. EIP itself is typically managed medically while a complication such as EBF, on the other hand, elicits far more invasive approaches in the form of open surgical intervention. We present the case of a 50 year-old male newly diagnosed with EIP complicated by EBF who was palliated with esophageal stenting. Upper endoscopy with esophageal stent placement offers a safe, feasible, and non-operative therapy for EIP and EBF.