Fetoscopic balloon dilation and stent placement of congenital high airway obstruction syndrome leading to successful Caesarian delivery

2022 ◽  
Author(s):  
Alice King ◽  
Joshua R. Bedwell ◽  
Deepak K. Mehta ◽  
Gary E. Stapleton ◽  
Henri Justino ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Stent Placement ◽  
Maternal Morbidity ◽  
Tracheoesophageal Fistula ◽  
Balloon Dilation ◽  
Laryngeal Stenosis ◽  
Tracheal Stent ◽  
Neonatal Hypoxia ◽  
Exit Procedure

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

A novel approach to the management of acute tracheal tear

2008 ◽  
Vol 122 (12) ◽  
pp. 1392-1393 ◽  
Author(s):  
B Creagh-Brown ◽  
A Sheth ◽  
A Crerar-Gilbert ◽  
B P Madden
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Review Of The Literature ◽  
Stent Deployment ◽  
Tracheal Stent ◽  
Large Airway ◽  
Novel Approach ◽  
Tracheal Tear

AbstractObjective:We describe the emergency use of a covered, expandable, removable tracheal stent in a patient who developed a large posterior tracheal tear complicating endobronchial therapy for large airway obstruction.Method:Case report and review of the literature concerning management of acute tracheal tear.Results and conclusion:Our patient demonstrates that endotracheal stenting is an option for managing acute large airway tear. Moreover, the use of a removable stent allows not only for rapid closure of the defect but also removal once the defect has healed, thus avoiding long-term complications of stent deployment.

scholarly journals Tracheoesophageal fistula managed with tracheal stent through flexible bronchoscopy without fluoroscopy

2016 ◽  
Vol 65 (4) ◽  
Author(s):  
G. Stratakos ◽  
C. Zisis ◽  
I. Bellenis ◽  
V. Filaditaki ◽  
A. Liapikou ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Stent Placement ◽  
Poor Prognosis ◽  
Tracheoesophageal Fistula ◽  
Therapeutic Option ◽  
Rigid Bronchoscopy ◽  
Flexible Bronchoscopy ◽  
Septic Complication ◽  
Tracheal Stent ◽  
Esophageal Stenting

Inoperable malignant tracheoesophageal fistula (TEF) is characterised by an extremely poor prognosis. Tracheal or double (tracheal-esophageal) stenting through rigid bronchoscopy has been suggested as a valuable therapeutic option. We report on a patient with a large TEF successfully sealed by deployment of a self-expandable stent through flexible bronchoscopy (FB) without fluoroscopy. Dramatically improved health status permitted him to undergo radiation, attaining further clinical improvement. Four months after stent placement no sequelae were observed. During the fifth month a new fistula developed distally to the stent finally leading to death from septic complication. Palliative management of inoperable malignant TEF by tracheal stent placement through FB without fluoroscopy, is feasible, safe and rewarding leading to important clinical improvement.

scholarly journals Laryngeal stent for acute and chronic respiratory distress in seven dogs with laryngeal paralysis

2020 ◽  
Vol 10 (1) ◽  
pp. 4-10 ◽  
Author(s):  
María Cecilia Ricart ◽  
Sergio Martín Rodríguez ◽  
Roberto Miguel Duré
Keyword(s):  
Respiratory Distress ◽  
Alternative Therapy ◽  
Clinical Signs ◽  
Surgical Techniques ◽  
Case Series ◽  
Laryngeal Function ◽  
Laryngeal Stenosis ◽  
Laryngeal Paralysis ◽  
Silicone Stent

Background: Laryngeal paralysis, failure of arytenoid cartilage, and vocal fold abduction are commonly seen in older medium to large breed dogs. Observation of laryngeal function in dogs and cats is performed by transoral visualization. There are a variety of surgical techniques; aspiration pneumonia is the most common complication associated with surgical correction of laryngeal paralysis. The aim of this case series is to report on the placement of a laryngeal silicone stent in seven dogs with laryngeal paralysis and its use as an alternative treatment of respiratory distress caused by laryngeal paralysis and/or its use for laryngeal stenosis as complication of laryngeal paralysis surgery.Case description: Seven dogs presented with either episode of gagging, mild-to-severe inspiratory distress, or cyanosis because of a laryngeal paralysis or laryngeal stenosis. In each case, the laryngeal paralysis was diagnosed by direct laryngoscopy. They were treated with a silicone laryngeal stent (Stening®) that substantially improved the clinical signs. Each dog had a different outcome because of other pathologies; however, the laryngeal pathology was successfully treated with the stent.Conclusion: The placement of the laryngeal stent is an easy technique to learn and practice, it could avoid the lifethreatening complications of the laryngeal paralysis at the acute phase, and it could be a noninvasive and long-term alternative therapy for laryngeal paralysis in dogs. The results in these clinical cases are encouraging for considering the laryngeal stent as a therapeutic alternative. Key words: Canine, Polyneuropathy, Prosthesis, Surgery.

Benign Tracheobronchial Stenoses: Long-term Clinical Experience with Balloon Dilation

2002 ◽  
Vol 13 (9) ◽  
pp. 909-914 ◽  
Author(s):  
Kwang-Hun Lee ◽  
Gi-Young Ko ◽  
Ho-Young Song ◽  
Tae Sun Shim ◽  
Woo Sung Kim
Keyword(s):  
Clinical Experience ◽  
Balloon Dilation

Long-Term Clinical Outcomes of Infrapopliteal Drug-Eluting Stent Placement for Critical Limb Ischemia in Diabetic Patients

2015 ◽  
Vol 26 (10) ◽  
pp. 1423-1430 ◽  
Author(s):  
Stavros Spiliopoulos ◽  
Vasiliki Theodosiadou ◽  
Konstantinos Katsanos ◽  
Panagiotis Kitrou ◽  
George C. Kagadis ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critical Limb Ischemia ◽  
Stent Placement ◽  
Limb Ischemia ◽  
Drug Eluting Stent ◽  
Diabetic Patients ◽  
Drug Eluting

scholarly journals Clinical evaluation the success rate and complications of fluoroscopically guided removal of tracheal tube metallic stents

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zong-Ming Li ◽  
De-Chao Jiao ◽  
Xin-Wei Han ◽  
Hui-Bin Lu ◽  
Ke-Wei Ren ◽  
...  
Keyword(s):  
Tracheal Tube ◽  
Granulation Tissue ◽  
Stent Placement ◽  
Covered Stent ◽  
Stent Fracture ◽  
Stent Group ◽  
Airway Stent ◽  
Uncovered Stents ◽  
Uncovered Stent

Abstract Background Long-term placement of airway stents has a high probability of restenosis of the airway due to granulation tissue hyperplasia, and it is difficult to remove the stent. Our aim is to evaluate the success rate and complications of removal of tracheal tube metallic stents under fluoroscopic guidance, and to compare the difference between uncovered stent and covered stent. Methods We retrospectively reviewed 45 cases (31 males and 14 females; age, 12–71 years) of tracheal metallic stent removal performed at our center between January 2014 and December 2019. Covered stents were applied in 36 cases, and uncovered stents were applied in 9 cases. In the covered stent group, 15 patients presented with granulation tissue at both ends; 3 cases, with stent fracture; and 2, with stent intolerance due to severe airway foreign body sensation. In the uncovered stents group, all patients presented with granulation tissue formation; 2 patients, with stent fracture; and 1 patient, with stent intolerance. Results A total of 41 (91.1%) stents were successfully removed (34 [94.4%] in the covered stent group and 7 [77.8%] in the uncovered stent group). The average duration of stent placement was 3.2 ± 0.7 and 2.5 ± 1.2 months in the covered stent group and uncovered stent group, respectively. With regard to the complications, hemoptysis occurred in 4 cases (average blood volume lost, 100 ml), tracheal mucosa tear occurred in 5 cases, tracheal collapse requiring emergency airway stent placement occurred in 1 case, and tracheal rupture requiring emergency surgical suture occurred in 1 case. No procedure-related deaths occurred in either group. Conclusions It is safe to remove the metal stent of the tracheal tube under the guidance of fluoroscopy, with low complications, and can avoid the long-term placement of the airway stent.

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