Procedures: Fellow Case Report Slide: Procedures |

An Unsual Cause of Tracheal Stenosis Due to a Vascular Anomaly Successfully Managed With Silicone Airway Stenting Prior to Definitive Vascular Repair FREE TO VIEW

John Egan, MD; Keith Bowersox, MD; Kevin Kovitz, MD; Neeraj Desai, MD
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Chicago Chest Center, Elk Grove Village, IL

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

Chest. 2016;150(4_S):995A. doi:10.1016/j.chest.2016.08.1101
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SESSION TITLE: Fellow Case Report Slide: Procedures

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 23, 2016 at 10:45 AM - 12:00 PM

INTRODUCTION: Airway stents are traditionally used to alleviate airway strictures in a variety of benign and malignant disease processes. We describe the successful deployment and subsequent removal of a silicone stent to treat extrinsic airway compression from a vascular anomaly until definitive surgical correction was performed.

CASE PRESENTATION: A 58-year-old woman presented with gradually worsening dyspnea on exertion. On physical exam she was noted to have stridor and imaging of her chest revealed narrowing in her mid trachea secondary to anomalous innominate artery. Given the severity of her symptoms, a rigid bronchoscopy was performed and critical narrowing of the mid trachea was observed. A 14x40mm silicone stent was then deployed and near complete patency of the mid trachea was achieved. The patient’s symptoms of dyspnea resolved and approximately two months later she underwent successful innominate aortic bypass. With the mid trachea no longer compressed repeat rigid bronchoscopy with stent removal was performed. Post stent removal, the entire trachea was noted to be widely patent and the patient was discharged in good condition.

DISCUSSION: Our patient had an unusual cause of tracheal stenosis due to an anomaly known as a bovine arch where the innominate artery shares a common origin with the left common carotid artery. Vascular anomolies can cause a myraid of airway disorders including extrinsic compression of central airways1. In our case, stenosis was successfully and safely managed with a removable silicone stent. These stents are durable, inexpensive, and easy to remove. Deployment requires rigid bronchoscopy with general anesthesia. Hybrid metallic stents are flexible, rarely migrate, and may be deployed through flexible bronchoscopy. However, they carry a theoretical risk of producing more granulation tissue than silicone stents making removal challenging. For these reasons, we chose to use a silicone stent for our patient as a temporizing measure given plan for definitive surgical correction of the innominate artery. After surgical correction the silicone stent was no longer needed and easily removed during repeat rigid bronchoscopy.

CONCLUSIONS: Silicone stents deployed by an interventional pulmonologist may offer patients a safe bridging therapy for extrinsic airway compression until they undergo correction of their vascular anomaly.

Reference #1: 1. Reed AB, Reed MF. Endobronchial and endovascular management of bronchial compression by a thoracic aortic aneurysm. Ann Thorac Surg. 2012 Jul;94(1):273-4.

DISCLOSURE: The following authors have nothing to disclose: John Egan, Keith Bowersox, Kevin Kovitz, Neeraj Desai

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