Outcome of TiNi Stent Treatments in Symptomatic Central Airway Stenoses Caused by Aspergillus fumigatus Infections After Lung Transplantation

Xie, Bo; Zhu, Yuming; Chen, C.; Zhao, Deping; Yang, Chenlu; Ding, Jian; Jiang, Gening

doi:10.1016/j.transproceed.2013.02.129

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…Immediate dyspnea relief is expected in up to 94% of patients after stent deployment [19, 20]. Concerns regarding long-term complications of SEMS for benign airway diseases have been raised [21, 22]. Previous reports have shown an overall 54% incidence of complications, of which 16–33% are due to infection, 12–36% due to granulation tissue formation, and 5% due to stent migration [18, 19, 21].…”

Section: Discussionmentioning

confidence: 99%

“…OSMBS were removed in 11 patients (78.6%) and 3 (21.4%) died with their stents in place. Median time between stent insertion and removal was 45 days (8-27); 71 days (8-267) in case of stenosis and 27 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) days in case of bronchial dehiscence. Among patients who had a stent removal, AC recurrence or complications indicating a new stent occurred in 4 (36.3%), with a median time of 7 days (0-29).…”

Section: Days)mentioning

confidence: 99%

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Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience

et al. 2022

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Background: In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative. Objectives: This retrospective study sought to assess the short- and long-term outcomes of patients treated with customized bifurcated stent (CBS) for the management of AC following LT. Methods: Data from patients with AC following LT requiring CBS placement between June 2010 and June 2020 were analyzed. Results: Four hundred patients underwent lung transplant. AC requiring airway stenting occurred in 32 patients (8%), and CBS were inserted in 15 patients (3.5%). Indications were stenosis (n = 12; 80%) and bronchial dehiscence (n = 3; 20%). CBS were successfully deployed in 14 patients and failed in 1 patient. No migration was recorded during the follow-up. The median number of complication was 1 per patient (0–5). CBS could be removed in 11 patients (78.6%), and 3 died with their stents in place. AC recurrence or complications requiring new stenting occurred in 4/11 patients (36.3%), with a median time of 7 days (0–29). Seven patients (63.7%) had no AC recurrence, with a median follow-up of 925 days (118–3,249). Conclusions: The actual surgical anastomotic technique in LT provides new endoscopic challenges. CBS seem ideally positioned to address these difficulties safely and effectively but are associated with stent related complications requiring further endoscopic management.

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Section: Discussionmentioning

confidence: 99%

Section: Days)mentioning

confidence: 99%

Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience

et al. 2022

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“…Fourthly, there is limited literature on the appropriate selection of airway stents for PTB. The deployment of metallic or hybrid airway stent has been reported in post-transplant tracheobronchial stump stenosis due to aspergillus infection (2,6). The use of silicone stents has been described only on rare occasions in the setting of Aspergillus tracheobronchial infection including one case for airway stenosis after treatment of bronchomediastinal fistula and another for post-tuberculosis tracheal stricture with superimposed PTB (7,8).…”

Section: Discussionmentioning

confidence: 99%

Complex multimodality central airway management of aspergillus pseudomembranous tracheobronchitis

2017

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A 69-year-old woman developed central airway obstruction due to invasive infection resulting in pseudomembranous tracheobronchitis (PTB). Several challenges were encountered in the airway management of this patient including her having relatively smaller airways which were more prone to obstruction by pseudomembranes and made airway interventions difficult. The patient had clinical deterioration in spite of antifungal therapy and bronchoscopic debridement. The multimodality airway techniques included the use of smaller biliary balloons for dilatation, using a hybrid stent to slowly dilate and maintain patency of right main stem and finally the insertion of right secondary carina peripheral Y stent, which resulted in clinical improvement and allowed time for antifungal therapy to take effect. To the best of our knowledge, the use of a peripheral Y stent has never been described in the setting of PTB.

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“…Immediate dyspnea relief is expected in up to 94% of patients after stent deployment [56,57]. Concerns regarding long-term complications of SEMS for benign airway diseases have been raised [58,59]. Previous reports have shown an overall 54% incidence of complications, of which 16-33% are due to infection, 12-36% due to granulation tissue formation and 5% due to stent migration [55,56,58].…”

Section: Bronchial Stenosis Following Lung Transplantationmentioning

confidence: 99%

“…Consequently, their use in benign disease should be cautious [58]. Recently, a new fully covered SEMS has been used with some success in post-LT anastomotic stenosis [59], but others failed to demonstrate any therapeutic advantage [60]. …”

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confidence: 99%

The use of self-expandable metallic stents in the airways in the adult population

Dutau¹,

Musani

Plojoux³

et al. 2014

Expert Review of Respiratory Medicine

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The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.KEYWORDS: airway stenting . benign airway stenosis . bronchoscopy . central airway obstruction . self-expandable metallic stentDumon was the first physician to place a dedicated and specially designed airway stent in 1987 in Marseille. This dedicated stent consisted of a silicone tube with small studs on the external surface to reduce migration [1]. Consequently, several companies started to develop other airway stents with silicone and metal. In the last 20 years, numerous reports have been published about the use of selfexpanding and balloon expandable metal stents for the treatment of tracheobronchial malignant and benign stenoses, tracheobronchomalacia (TBM), fistulas and dehiscences [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].Self-expandable stents are made of a shapememory alloy, generally nitinol (nickel-titanium). When the stent is released, it expands spontaneously to reach its original shape and diameter. On the other hand, balloon expandable metallic stents (the first generation of airway metallic stents) were made of metal (steel) meshes that did not possess a memory shape. A balloon was then necessary to deploy them. Most of these stents had originally been developed for use in the vascular system but were found to be adequate for placement in the central airways after only minor modifications, if any at all. The latest developments include stents made of shape memory alloys and composite stents made from metals and polymers [17][18][19]. But, so far, the Dumon stent (Tracheobronxane Ò , Novatech, La Ciotat, France) remains the most commonly placed stent worldwide. Dumon stents have been the 'gold standard' for the treatment of benign and malignant airway stenoses over the past 20 years [20,21], with two specific designs: straight and Y-shaped (for disease involving the carina) [22]. By the way, it is interesting to notice that, in the Thoracic Endoscopy Unit of Marseille, where the Dumon stent was conceptualized and used, the percentage of silicone stent placement has dropped from 100% in 2000 to 65% in 2013. The remaining 35% of the stents used are now fully covered, selfexpandable, metallic stents (SEMS). This goes to prove that the Dumon stents are not the ideal stents in all situa...

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Outcome of TiNi Stent Treatments in Symptomatic Central Airway Stenoses Caused by Aspergillus fumigatus Infections After Lung Transplantation

Cited by 8 publications

References 25 publications

Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience

Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience

Complex multimodality central airway management of aspergillus pseudomembranous tracheobronchitis

The use of self-expandable metallic stents in the airways in the adult population

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