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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marco Anile Tiziano De Giacomo Federico Venuta Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anile, M. Articles by Venuta, F. Search for Related Content PubMed PubMed Citation Articles by Anile, M. Articles by Venuta, F. Related Collections Lung - other Trachea and bronchi Great vessels Related Article

J Thorac Cardiovasc Surg 2006;132:991
© 2006 The American Association for Thoracic Surgery

Letter to the Editor

Tracheal stents in patients with malignancy

University of Rome "La Sapienza", Policlinico Umberto I, Department of Thoracic Surgery, 00161 Rome, Italy

To the Editor:

We read with interest the article by Sihvo and colleagues¹ titled "Fatal Fistula Between the Trachea and the Brachiocephalic Artery: Late Complication of a Second-Generation, Self-Expanding Metallic Tracheal Stent."

In recent years, the use of this new type of stent has become more frequent, with a consequent improvement of quality of life and survival in patients affected by inoperable malignant disease or benign disorders. The use of these stents has been encouraged by their easy deployment, which often can be performed through a fiberoptic bronchoscope. However, they are expensive, and sometimes their use can be questioned in patients with a relatively limited life expectancy and tendency to neoplastic tissue growth. The second-generation self-expanding metallic stents reach the largest diameter in 36 to 48 hours after deployment. Covered stents should be preferred, especially in the case of malignancy, to avoid tissue grow within the mesh of the stent and formation of granulations.

Traditionally, we have preferred silicone stents (Dumon stents; Novatech, La Ciotat Cedex, France), having placed more than 200 of them over a period of 13 years. Erosion was never a complication. Minor complications were secretion retention and granulations on one edge of the stent (1% in the neoplastic population); also, displacement never happened in patients with cancer. We also have a small experience with self-expandable stents (12 patients with 14 stents); however, they were used in a very well selected group of patients with difficult anatomic situations, and most of them had a tortuous posttransplant bronchial stenosis with a malacic component.

In the text of the article it is not clear whether the first two stents, and in particular the first one used in that patient, were covered or not. Could the authors clarify this?

Again, we encourage the use of silicone stents in patients with malignant tumors; they are less expensive, easy to place, and can be removed or changed if required by the clinical situation.

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1. Sihivo EI, Sioris T, Tynnien O, Salo JA. Fatal fistula between the trachea and the brachiocephalic artery: late complication of a second-generation, self-expanding metallic tracheal stent. J Thorac Cardiovasc Surg 2006;131:1415-1416.[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Marco Anile Tiziano De Giacomo Federico Venuta Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Anile, M. Articles by Venuta, F. Search for Related Content PubMed PubMed Citation Articles by Anile, M. Articles by Venuta, F. Related Collections Lung - other Trachea and bronchi Great vessels Related Article