Tracheal stent placement via a tracheostomy for tracheal stenosis after inhalation injury

Introduction: Without fetal or perinatal intervention, congenital high airway obstruction syndrome (CHAOS) is a fatal anomaly. The ex utero intrapartum treatment (EXIT) procedure has been used to secure the fetal airway and minimize neonatal hypoxia, but is associated with increased maternal morbidity. Case Presentation: A 16-year-old woman (gravida 1, para 0) was referred to our hospital at 31 weeks gestation with fetal anomalies, including echogenic lungs, tracheobronchial dilation and flattened diaphragms. At 32 weeks, fetoscopic evaluation identified laryngeal stenosis, which was subsequently treated with balloon dilation and stent placement. The patient developed symptomatic and regular preterm contractions at post-operative day 7 with persistent sonographic signs of CHAOS, which prompted a repeat fetoscopy with confirmation of a patent fetal airway followed by Cesarean delivery under neuraxial anesthesia. Attempts to intubate through the tracheal stent were limited and resulted in removal of the stent. A neonatal airway was successfully established with rigid bronchoscopy. Direct laryngoscopy and bronchoscopy confirmed laryngeal stenosis with a small tracheoesophageal fistula immediately inferior to the laryngeal stenosis and significant tracheomalacia. A tracheostomy was then immediately performed for anticipated long term airway and pulmonary management. The procedures were well tolerated by both mom and baby. The baby demonstrated spontaneous healing of the tracheoesophageal fistula by day of life 7 with discharge home with ventilator support at three months of life. Conclusion: Use of repeated fetoscopy in order to relieve fetal upper airway obstruction offers the potential to minimize neonatal hypoxia, while concurrently decreasing maternal morbidity by avoiding an EXIT procedure. Use of the tracheal stent in CHAOS requires further investigation. The long-term reconstruction and respiratory support of children with CHAOS remain challenging

Download Full-text

P-232A SIMPLE TECHNIQUE TO FACILITATE DUMON SILICONE STENT PLACEMENT IN SUBGLOTTIC TRACHEAL STENOSIS

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivt288.232 ◽

2013 ◽

Vol 17 (suppl_1) ◽

pp. S60-S60

Author(s):

Alfonso Fiorelli ◽

S. Mazzone ◽

V.G. Di Crescenzo ◽

G. Vicidomini ◽

S. Costanza ◽

...

Keyword(s):

Tracheal Stenosis ◽

Stent Placement ◽

Simple Technique ◽

Silicone Stent

Download Full-text

Experience of Expandable Metallic Stent Placement for Tracheal Stenosis.

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.44.472 ◽

1993 ◽

Vol 44 (6) ◽

pp. 472-476

Author(s):

Takaaki Kawaguchi ◽

Yutaka Katoh ◽

Hiromu Kakiuchi ◽

Takaaki Kimura ◽

Yasuhiro Hayashi ◽

...

Keyword(s):

Tracheal Stenosis ◽

Stent Placement ◽

Metallic Stent ◽

Expandable Metallic Stent ◽

Metallic Stent Placement

Download Full-text

New tracheal stainless steel stent pilot study: twelve month follow-up in a rabbit model

PeerJ ◽

10.7717/peerj.7797 ◽

2019 ◽

Vol 7 ◽

pp. e7797 ◽

Cited By ~ 2

Author(s):

Sandra Lopez-Minguez ◽

Carolina Serrano-Casorran ◽

Jose A. Guirola ◽

Sergio Rodriguez-Zapater ◽

Cristina Bonastre ◽

...

Keyword(s):

Pilot Study ◽

Stent Placement ◽

Clinical Success ◽

Rabbit Model ◽

Absorbable Suture ◽

Safe Procedure ◽

Tracheal Stent ◽

Airway Pathology ◽

Tracheal Collapse

Background Canine tracheal collapse is a complex airway pathology without promising treatment results. Currently nitinol stents are the best surgical option; however, some professionals are doubting if stent placement is the best option due to the associated complications. Objective Determine the technical feasibility, safety, and long-term follow-up after the implantation of a new tracheal stent designed for canine tracheal collapse. Methods Thirteen healthy, adult female New Zealander rabbits were involved in this pilot study.A new intra-tracheal device (Reference number 902711 patent registered as CasMin-Twine) was implanted in ten animals. Deployment was performed under general anesthesia, making a puncture incision via a 21 Gauge needle in the intra-tracheal space where the stent was introduced with a screwing process. The device was fixed to the tracheal wall with a non-absorbable suture. Computerized Tomography (CT) and an endoscopy to study structural abnormalities were performed after 30, 90 and 365 days after stent placement. Results Technical and clinical success was 100%. There was no significant change in behavior or respiratory disorders. CT studies showed no significant alterations. After the 30 days, 60% of the animals showed partial endothelization in the endoscopy study, and only one animal still presented partial endothelization after 12 months. Mucus accumulation was only present in 40% of cases and classified as low, without respiratory consequences. Only one animal presented a single granuloma at caudal stent tip. Conclusions This new tracheal stent (CasMin-Twine) is an effective and safe procedure with promising results, and also shows the possibility of removing the device after endothelization has been produced. New studies should be carried out to evaluate the effectiveness in patients with tracheomalacia. Clinical Significance/Impact This new product can give veterinarians a new option of treatment for this complicated pathology. Minimizing specific equipment for its deployment, CasMin-Twine will be more accessible for all professionals.

Download Full-text