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Endobronchial Prostheses

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Interventions in Pulmonary Medicine

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Abstract

Airway stents have been consistently shown to help patients suffering from central airway obstruction and esophagorespiratory fistulas, by improving airflow, quality of life, and survival. These prostheses, however, are foreign objects within the airways, and adverse events are expected. The incidence rate of these events depends on patient-related factors and on specific stent-tissue interactions. Stent insertion is generally reserved for patients for whom curative open surgical interventions are not feasible or contraindicated. Metallic stents should be avoided in histologically benign disease unless surgery or silicone stent placement is not possible. For malignant disease, stents are usually placed with a palliative intent and should be inserted to offer comfort without harming the terminally ill patient; therefore, they should be placed by operators able to manage intraoperative, short-term, and long-term complications after a careful analysis of expected benefits. Long-term stent-related complications are not uncommon and can occasionally be fatal. Since not all stents are equivalent in terms of biomechanics and stent-tissue interactions, manufactures should probably describe these properties including the resistance to angulation, expansile force, and mechanical failure, not only to assure restoration of airway patency after insertion but also to potentially predict immediate and long-term stent-related complications.

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Notes

  1. 1.

    Central airway obstruction is defined in this chapter as any clinically significant narrowing of the airway from the subglottis to the lobar bronchi.

  2. 2.

    These include rigid or flexible bronchoscopic resection, laser, electrocautery, cryotherapy, photodynamic therapy, or brachytherapy and are described in detail in other chapters in this book.

  3. 3.

    Coexistent diseases: coronary heart disease, severe cardiac or respiratory insufficiency or poor general condition.

  4. 4.

    Granulation tissue formation at the proximal end of the T-tube has also been described, and it is believed that chronic airway irritation incites infection and promotes or aggravates granulation tissue formation.

  5. 5.

    In this study, patients with esophageal carcinoma involving the airway mostly required only stent placement without laser-assisted debulking, probably because the main problem was extrinsic compression.

  6. 6.

    An incidence proportion is defined as the number of cases with complications divided by the number of cases overall and is an appropriate measure for analyzing immediate perioperative complications [6].

  7. 7.

    It measures events per person-time at risk [6].

  8. 8.

    An electrical current in which the electron flow is in only one direction; galvanic currents cause fibroblasts proliferation resultant increase in collagen synthesis, property used for wound healing and also implicated in keloid formation.

  9. 9.

    Especially in patients with tumors who might have a nearly horizontal left main bronchus due to large subcarinal adenopathy.

  10. 10.

    In this regard, histologically benign CAO should be treated surgically or for nonsurgical candidates, with silicone stents whenever possible.

  11. 11.

    Other conditions include experienced bronchoscopist and team, experienced anesthesiologist, control of patient’s overall performance status, additional systemic or local therapy still possible, and control of comorbidities.

  12. 12.

    One way to assess the perfusion status of lung parenchyma distal to an airway obstruction is to attempt bypassing the stenosis using a high-resolution EBUS radial probe.

Abbreviations

6MWT:

Six-minute walk test

BAO:

Benign airway obstruction

BPF:

Bronchopleural fistula

CAO:

Central airway obstruction

CPAP:

Continuous positive airway pressure

CT:

Computed tomography

DATS:

Dynamic A-shaped tracheal stenosis

EBUS:

Endobronchial ultrasound

ECAC:

Expiratory central airway collapse

EDAC:

Excessive dynamic airway collapse

EPP:

Equal pressure point

ERF:

Esophagorespiratory fistulas

ETT:

Endotracheal tube

FLS:

Flow-limiting segment

HRQOL:

Health-related quality of life

IOS:

Impulse oscillometry

MAO:

Malignant airway obstruction

MRC:

Medical Research Council

P lat:

Lateral airway pressure

PL:

Intraluminal pressure

POTS:

Postoperative tracheal stenosis

Ppl:

Pleural pressure

QOL:

Quality of life

R:

Resistance

RP:

Relapsing polychondritis

RRP:

Recurrent respiratory papillomatosis

SEMS:

Self-expandable metallic stents

TBM:

Tracheobronchomalacia

TLC:

Total lung capacity

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Authors and Affiliations

  1. The University of Chicago Medicine, 5841 S Maryland Ave, MC 6076, Chicago, IL, 60637, USA

    Septimiu Dan Murgu MD, FCCP & Sean Patrick Stoy MD

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  1. Septimiu Dan Murgu MD, FCCP
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Correspondence to Septimiu Dan Murgu MD, FCCP .

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  1. Clínica Corachan and Bellvitge, University Hospital, Barcelona, Spain

    Jose Pablo Díaz-Jimenez

  2. Pulmonary Department, Clinica y Maternidad Colon, Pulmonary Research Department, IIC Mar del Plata, Buenos Aires, Argentina

    Alicia N. Rodriguez

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Murgu, S.D., Stoy, S.P. (2018). Endobronchial Prostheses. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-58036-4_13

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