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J Thorac Cardiovasc Surg 2003;126:744-747
© 2003 The American Association for Thoracic Surgery
General thoracic surgery |
a Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA
Presented in part at the Chest 2002 meeting of the American College of Chest Physicians, San Diego, Calif, Nov 2-7, 2002.
Received for publication December 30, 2002; revisions received February 7, 2003; revisions received February 10, 2003; accepted for publication February 14, 2003.
* Address for reprints: Henning A. Gaissert, MD, Massachusetts General Hospital, Blake 1570, Fruit Street, Boston, MA 02114, USA
hgaissert{at}partners.org
OBJECTIVES: Self-expanding metal stents are used to palliate benign strictures. We examined the complications of this approach.
METHODS: Between 1997 and 2002, we observed recurrent airway obstruction and extension of benign inflammatory strictures after the placement of tracheobronchial Microvasive Ultraflex stents and Wallstents (Boston Scientific Corp, Natick, Mass), in 10 patients with postintubation strictures and 5 with other indications; all but 1 patient were referred to us. Patients with tracheal (9), subglottic (1), combined tracheal and subglottic (3), and bronchial (2) strictures had been treated with covered and uncovered Wallstents (6) and Microvasive Ultraflex stents (9).
RESULTS: After stent insertion, stricture and granulations within previously normal airway were seen in all patients. New subglottic strictures resulting from the stent caused hoarseness in 4 patients. A bronchoesophageal fistula was found in 1 patient at presentation and a tracheoesophageal fistula in another during extraction of a Wallstent. Primary surgical reconstruction, judged to have been feasible before wire stent insertion in 10 patients, was possible after stenting in only 7 and failed in 2. Palliative tubes were placed in 60% (9/15). Self-expanding metal stents may lengthen luminal damage, incite subglottic strictures, and cause esophagorespiratory fistula in inflammatory airway strictures. The injury is severe, occurs after a short duration of stenting, and precludes definitive surgical treatment or requires more extensive tracheal resection.
CONCLUSION: The current generation of self-expanding metal stents should be avoided in benign strictures of trachea and bronchi.
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