Use of an Expandable Metallic Stent with a Silicon Stent in the Treatment of Extrinsic Tracheal Obstruction: A Safe Method for Long-Term Endotracheal Stenting

Introduction

Expandable metallic stents (EMS) have been used for children with a variety of difficult airway problems.[1] [2] [3] Although the efficacy of the EMS on relieving airway stenosis has been thoroughly described, the long-term outcome of the EMS remains unclear. There are several reports of life-threatening complications caused by EMS used for pediatric airway management.[4] [5] This report presents a case of an extrinsic tracheal obstruction, in which an EMS was used in combination with a silicon stent to avoid the occurrence of serious respiratory complications.

• References

• 1 Filler RM, Forte V, Fraga JC, Matute J. The use of expandable metallic airway stents for tracheobronchial obstruction in children. J Pediatr Surg 1995; 30 (7) 1050-1055 , discussion 1055–1056
• 2 Tazuke Y, Kawahara H, Yagi M , et al. Use of a Palmaz stent for tracheomalacia: case report of an infant with esophageal atresia. J Pediatr Surg 1999; 34 (8) 1291-1293
• 3 Maeda K, Yasufuku M, Yamamoto T. A new approach to the treatment of congenital tracheal stenosis: Balloon tracheoplasty and expandable metallic stenting. J Pediatr Surg 2001; 36 (11) 1646-1649
• 4 Alfaro J, Varela G, De-Miguel E, Martin de Nicolas JL. Successful management of a tracheo-innominate artery fistula following placement of a wire self-expandable tracheal Gianturco stent. Eur J Cardiothorac Surg 1993; 7 (11) 615-616
• 5 Cook CH, Bhattacharyya N, King DR. Aortobronchial fistula after expandable metal stent insertion for pediatric bronchomalacia. J Pediatr Surg 1998; 33 (8) 1306-1308
• 6 Abdel-Rahman U, Ahrens P, Fieguth HG, Kitz R, Heller K, Moritz A. Surgical treatment of tracheomalacia by bronchoscopic monitored aortopexy in infants and children. Ann Thorac Surg 2002; 74 (2) 315-319
• 7 Kamata S, Usui N, Sawai T , et al. Pexis of the great vessels for patients with tracheobronchomalacia in infancy. J Pediatr Surg 2000; 35 (3) 454-457
• 8 Sakamoto T, Nagase Y, Hasegawa H, Shin'oka T, Tomimatsu H, Kurosawa H. One-stage intracardiac repair in combination with external stenting of the trachea and right bronchus for tetralogy of Fallot with an absent pulmonary valve and tracheobronchomalacia. J Thorac Cardiovasc Surg 2005; 130 (6) 1717-1718
• 9 Johnston MR, Loeber N, Hillyer P, Stephenson LW, Edmunds Jr LH. External stent for repair of secondary tracheomalacia. Ann Thorac Surg 1980; 30 (3) 291-296
• 10 Corno A, Giamberti A, Giannico S , et al. Airway obstructions associated with congenital heart disease in infancy. J Thorac Cardiovasc Surg 1990; 99 (6) 1091-1098
• 11 Furman RH, Backer CL, Dunham ME, Donaldson J, Mavroudis C, Holinger LD. The use of balloon-expandable metallic stents in the treatment of pediatric tracheomalacia and bronchomalacia. Arch Otolaryngol Head Neck Surg 1999; 125 (2) 203-207
• 12 Miyamoto T, Ishida R, Noma M, Chikada M, Sekiguchi A. Successful surgical management of a tracheopulmonary artery fistula caused by an intratracheal expandable metal stent. Jpn J Thorac Cardiovasc Surg 2001; 49 (10) 632-634
• 13 Filler RM, Forte V, Chait P. Tracheobronchial stenting for the treatment of airway obstruction. J Pediatr Surg 1998; 33 (2) 304-311
• 14 Kao SC, Chang WK, Pong MW, Cheng KW, Chan KH, Tsai SK. Welded tracheal stent removal in a child under cardiopulmonary bypass. Br J Anaesth 2003; 91 (2) 294-296
• 15 Okuyama H, Kubota A, Kawahara H, Oue T, Nose S, Ihara T. Tracheal obstruction caused by an expandable metallic stent: a case of successful removal of the stent. Pediatr Surg Int 2005; 21 (7) 573-575
• 16 Miwa K, Takamori S, Hayashi A, Fukunaga M, Shirouzu K. Fixation of silicone stents in the subglottic trachea: preventing stent migration using a fixation apparatus. Ann Thorac Surg 2004; 78 (6) 2188-2190