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Procedures: Procedures: Bronchology |

Silicone Stent for Treatment of Excessive Dynamic Airway Collapse: Not a Benign Treatment Modality FREE TO VIEW

Deepankar Sharma, MD; Arjun Chatterjee, MD
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Wake Forest University School of Medicine, Winston Salem, NC


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A426. doi:10.1016/j.chest.2016.02.444
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SESSION TITLE: Procedures: Bronchology

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Excessive dynamic airway collapse (EDAC) refers to excessive bulging of the posterior wall of trachea during exhalation causing reduction in lumen by more than 50%. Non-invasive positive pressure ventilation is an effective treatment option. Airway stents have also been used to treat EDAC but are associated with variety of complications such as migration, granulation tissue, infection, retained secretions and obstruction. We describe a patient who developed all such complications after silicone stent placement.

CASE PRESENTATION: 75 y/o man with history of CAD and CVA who presented with acute on chronic cough and dyspnea on exertion. He developed rapidly worsening respiratory failure and septic shock requiring mechanical ventilation and vasopressors. His chest X-ray showed a tracheal stent and a flexible bronchoscopy revealed a silicone intratracheal stent which had migrated distally and had a significant amount of granulation tissue at the distal end causing partial obstruction of bilateral main stem bronchi along with copious purulent secretions. An attempt to reposition the stent using biopsy forceps was unsuccessful as the attempt to debulk the granulation tissue with cryotherapy. He was then taken to the OR and the stent was removed using suspension laryngoscopy. His trachea demonstrated near complete collapse after stent removal and the patient required tracheostomy to maintain his airway. He was later discharged to a chronic ventilator facility for rehabilitation.

DISCUSSION: Silicone stents are frequently used to treat EDAC but are associated with complications such as migration, granulation tissue, infection and obstruction. The overall complication rate is 42% with stent migration being the most common and 40-50% of patients require an emergent bronchoscopic procedure. Our patient encountered multiple complications from the silicone stent and finally ended up with an extra long tracheostomy tube to treat his EDAC.

CONCLUSIONS: Silicone stents may cause long-term complications particularly in patients with benign diseases who have a longer life expectancy. Thus, careful consideration of indications and patient selection are required while using silicone stents for treatment of EDAC.

Reference #1: Tracheobronchomalacia and excessive dynamic airway collapse. Murgu, Colt H. Clin Chest Med. 2013 Sep.

Reference #2: Airway stents. Chin CS1, Litle V, Yun J, Weiser T, Swanson SJ. Ann Thorac Surg. 2008 Feb.

DISCLOSURE: The following authors have nothing to disclose: Deepankar Sharma, Arjun Chatterjee

No Product/Research Disclosure Information


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