Tracheobronchial Stenting for Benign Airway Stenosis

Abstract

PURPOSE: To review the experience of tracheobronchial stenting in benign airway stenosis over a fifteen year period in a tertiary cardiothoracic unit. METHOD(S): Case notes of patients who underwent tracheobronchial stenting for benign conditions between December 1994 and December 2009 were identified and retrospectively reviewed. RESULT(S): Between 1994 to 2009, 23 patients received Dumon stent for benign stenosis: eight males and fifteen females, mean age 43.5 years. Underlying pathology: tuberculosis 19, postintubation 2, traumatic 2, relapsing polychondritis 1. Presenting symptoms: dyspnoea 13, respiratory failure 5, wheeze 2, cough 3. 26 straight Dumon stents were inserted at the first operation: 20 patients received one stent, and three received two stents. There were five perioperative complications (21.7%): tracheobronchial tear 4 (17.4%), pneumothorax 1. Two died perioperatively (8.7%), both were patients with tracheobronchial tears. Of the remaining tracheobronchial tears, one required prolonged ICU stay, and one had aborted stenting. Mean follow up was 47.4 months (range 7 to 180 months). Three patients died of unrelated causes. Stent removal was performed in 5, but 3 subsequently required restenting. 35 stent revisions were performed in 14 patients (60.8%): granulation tissue 20, migration 11, TB progression 2, tracheobronchial tear 2. There were four stenting failures(17.9%): tracheal stenosis distal to the stent requiring tracheostomy; CPAP dependence for distal airway collapse from chondromalacia; two failed disobliterations from granulation obstruction distal to the stent. In the remaining 14 patients, 1 had stent removal after 24 months and remained well. 13 patients had Dumon stents for a mean of 48.9 months. Two patients required ongoing stent revisions (8.6%). The remaining eleven patients (47.8%) all reported marked improvement in symptoms. CONCLUSION(S): Endobronchial tuberculosis accounted for the majority of benign airway stenosis. Stenting achieved symptomatic improvement in 47.8% of patients, but granulation tissue/migration related revision rate is high. Tracheobronchial tear predicts perioperative death, ICU stay or procedure failure. CLINICAL IMPLICATIONS: Tracheobronchial stenting for benign airway stenosis produces symptomatic improvement but multiple revisions is expected. Tracheobronchial tear poses daunting clinical challenges.