SESSION TYPE: Therapeutic Bronchoscopy
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: A well recognized risk of airway stenting is their proclivity to migrate thereby reducing their effectiveness and posing the risk of airway obstruction. An alternative method of securing airway stents is proposed.
METHODS: I present 2 cases of airway stent fixation using commonly available surgical material. The propensity of certain stents to move or migrate in the airway is well recognized. In 1 case a pneumonectomized patient suffered total dehiscence of his right mainstem bronchus causing a severe air leak into his Eloesser flap and recurrent pneumonia. His powerful cough had dislodged prior stents and therefore he was upsized to a larger nitinol stent which was fixed to his trachea using 2 absorbable tacks (Pro-tak 5mm). Each tack was placed using rigid bronchoscopy and firing the tack through the stent into the airway. These were easily extracted several weeks later, after his Eloesser flap was closed and his stent was removed. The second case involved an esophagectomy patient who suffered perforation of his right mainstem bronchus. A appropriately sized covered nitinol stent (Alveolus) was placed to occlude the defect but less than an hour later the patient coughed it up into his trachea and occluded his left mainstem bronchus. He was intubated and taken back to rigid bronchoscopy where his stent was repositioned and fixed to the airway using a single metallic tack (Perm-tak 5mm) with excellent results.
RESULTS: Both patients suffered migration of appropriately sized stents used to occlude an airway defect. Both underwent repeat stenting followed by insertion of tacks designed for use in the abdomen to fix mesh to the anterior abdominal wall. In each case, rigid bronchoscopy was required to allow passage of the delivery device. No adverse effect was seen but the relative short length of the delivery “gun” limits opportunities to the trachea and proximal mainstem bronchii.
CONCLUSIONS: Nitinol based stents can be fixed to the airway wall by use of commonly available surgical tacks during rigid bronchoscopy.
CLINICAL IMPLICATIONS: Fixing stents to the airway wall using commonly available surgical tacks offers the interventionalist a new method of reducing the possibility of stent migration.
DISCLOSURE: The following authors have nothing to disclose: John Hinze
No Product/Research Disclosure InformationPulmonary and Critical Care Consultants of Austin, Austin, TX