Clinical outcomes of metallic Y-shaped covered stents for bronchopleural fistula around upper carina after lobectomy

Abstract

BackgroundFew studies have reported the placement of metallic Y-shaped covered stents (Y stents) for bronchopleural fistula around the upper carina.MethodsEighteen patients were treated with Y stents insertion under the guidance of fluoroscopy. All covered stents were custom-designed and inserted to fit the upper carina anatomy. Clinical data and medical imaging data were analyzed retrospectively.ResultsThe stents were implanted successfully for the first time in 17 patients, and one patient needed a second attempt due to stent migration during withdrawal of the guide wires. In total, 19 small Y single-plugged stents were inserted in the upper carina and 5 large Y stents additionally in the main carina. Nineteen complications were observed in 14 patients, including 4 major complications. Stents were successfully removed in 12 patients due to complications or cure efficacy, for a median duration in place of 89.5 days. One patient lost follow-up. Nine patients were cured, and three had clinical improvement. One patient died of ventricular fibrillation the second day after the procedure and 4 patients died of tumors 7.8 to 91.7 months after stent placement. The 1-, 3-, and 5-year survival rates were 87.5, 80.8 and 80.8%, respectively.ConclusionsMetallic Y stent placement is technically feasible, effective and safe for bronchopleural fistula disease around the upper carina.

Long-term follow up and comparison between conservative and interventional therapy in postoperative bronchopleural fistula—a cohort study

“…Reintervention strategy differed from person to person. Furthermore, mechanical ventilation and preoperative pleuropulmonary infection might be correlated with postoperative BPF ( 1 , 12 , 21 , 22 ). We decreased peak inspiratory pressure (PIP) by using lower tidal volumes, lower PEEP, decreasing the inspiratory time, and decreasing the respiratory rate to improve BPF patients’ ventilation.…”

Clinical outcomes and survival following placement of self‐expandable metallic stents for central airway stenosis and fistula

“…Metallic Yshaped stent placement has been shown to be technically feasible, effective and safe for a bronchopleural fistula around the upper carina. 15 Third-generation fully-covered SEMSs are a safe treatment option for complex benign airway stenosis, but complications requiring stent removal have been frequently reported. 16 It is controversial whether a patient with acute respiratory failure is a candidate or not for a stent replacement, because of a poor prognosis after stent replacement.…”

“…To mitigate stent migration, we chose a more suitable larger Ultraflex or added a baloon inside the stent. Metallic Y‐shaped stent placement has been shown to be technically feasible, effective and safe for a bronchopleural fistula around the upper carina 15 . Third‐generation fully‐covered SEMSs are a safe treatment option for complex benign airway stenosis, but complications requiring stent removal have been frequently reported 16 …”