Advertisement

CardioVascular and Interventional Radiology

, Volume 42, Issue 3, pp 426–432 | Cite as

Multiple Bifurcated Covered Self-Expanding Metallic Stents for Complex Tracheobronchial Fistulas or Stenosis

  • Yonghua Bi
  • Jindong Li
  • Zepeng Yu
  • Jianzhuang Ren
  • Xinwei HanEmail author
  • Gang WuEmail author
Clinical Investigation Non-Vascular Interventions
  • 38 Downloads
Part of the following topical collections:
  1. Non-Vascular Interventions

Abstract

Objective

We aimed to determine the safety and feasibility of bifurcated covered self-expanding stents for the treatment of complex tracheobronchial fistulas or stenosis.

Methods

Twenty-eight patients were treated by multiple bifurcated covered airway stents (Micro-Tech Co. Ltd., Nanjing, China), including 18 cases of gastrobronchial or gastrotracheal fistula, 6 cases of bronchopleural fistula and 4 cases of severe tracheobronchial stenosis. The large bifurcated covered stent was placed at the main carina, and the small stents were inserted into primary right carina or secondary left carina. Clinical and imaging data were retrospectively analyzed.

Results

Stents were successfully inserted in 27 patients at the first attempt. In total, 29 large bifurcated covered stents, 27 small bifurcated covered stents and 5 small bifurcated covered single-plugged stents were inserted. All patients with fistula could resume eating without coughing after the procedure. No perioperative death or severe complications occurred. Two patients underwent stent removal due to intolerance of stenting; the clinical success rate was 93% (26/28). Nineteen complications were found in 12 patients; 8 patients needed stent removal or replacement, for a major complication rate of 29% (8/28). Eight patients underwent successful stent removal due to complications. Fifteen patients died of tumors and one patient died of pulmonary infection. The median survival was 33 months. Fistula recurrence was found in one patient 5 months after stenting, and second small bifurcated covered stent was inserted.

Conclusions

Multiple bifurcated covered metallic stenting is effective and safe for complex tracheobronchial fistulas or stenosis, with good symptom palliation.

Keywords

Respiratory tract fistula Tracheal stenosis Stents Fluoroscopy Postoperative complications 

Notes

Acknowledgements

This work was supported by National Natural Science Foundation of China (Grant No. 81501569). This study was approved by the Ethics Committee and Medical Records Management Section of the First Affiliated Hospital of Zhengzhou University.

Compliance with Ethical Standards

Conflict of interest

The authors declared that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Turk AE, Karanas YL, Cannon W, Chang J. Staged closure of complicated bronchopleural fistulas. Ann Plast Surg. 2000;45:560–4.CrossRefGoogle Scholar
  2. 2.
    Fernando HC, Sherwood JT, Krimsky W. Endoscopic therapies and stents for benign airway disorders: where are we, and where are we heading? Ann Thorac Surg. 2010;89:S2183–7.CrossRefGoogle Scholar
  3. 3.
    Simonds AK, Irving JD, Clarke SW, Dick R. Use of expandable metal stents in the treatment of bronchial obstruction. Thorax. 1989;44:680–1.CrossRefGoogle Scholar
  4. 4.
    Han X, Li L, Zhao Y, Liu C, Jiao D, Ren K, et al. Individualized airway-covered stent implantation therapy for thoracogastric airway fistula after esophagectomy. Surg Endosc. 2017;31:1713–8.CrossRefGoogle Scholar
  5. 5.
    Han X, Wu G, Li Y, Li M. A novel approach: treatment of bronchial stump fistula with a plugged, bullet-shaped, angled stent. Ann Thorac Surg. 2006;81:1867–71.CrossRefGoogle Scholar
  6. 6.
    Wu G, Li ZM, Han XW, Wang ZG, Lu HB, Zhu M, et al. Right bronchopleural fistula treated with a novel, Y-shaped, single-plugged, covered, metallic airway stent. Acta Radiol. 2013;54:656–60.CrossRefGoogle Scholar
  7. 7.
    Cui YF, Fu YF, Li DC, Xu H. Percutaneous recanalization for hepatic vein-type Budd-Chiari syndrome: long-term patency and survival. Hepatol Int. 2016;10:363–9.CrossRefGoogle Scholar
  8. 8.
    Stockton PA, Ledson MJ, Hind CR, Walshaw MJ. Bronchoscopic insertion of Gianturco stents for the palliation of malignant lung disease: 10 year experience. Lung Cancer. 2003;42:113–7.CrossRefGoogle Scholar
  9. 9.
    Prasad M, Bent JP, Ward RF, April MM. Endoscopically placed nitinol stents for pediatric tracheal obstruction. Int J Pediatr Otorhinolaryngol. 2002;66:155–60.CrossRefGoogle Scholar
  10. 10.
    Han X, Al-Tariq Q, Zhao Y, Li L, Cheng Z, Wang H, et al. Customized Hinged Covered Metallic Stents for the Treatment of Benign Main Bronchial Stenosis. Ann Thorac Surg. 2017;104:420–5.CrossRefGoogle Scholar
  11. 11.
    Thornton RH, Gordon RL, Kerlan RK, LaBerge JM, Wilson MW, Wolanske KA, et al. Outcomes of tracheobronchial stent placement for benign disease. Radiology. 2006;240:273–82.CrossRefGoogle Scholar
  12. 12.
    Park JH, Kim PH, Shin JH, Tsauo J, Kim MT, Cho YC, et al. Removal of Retrievable Self-Expandable Metallic Tracheobronchial Stents: an 18-Year Experience in a Single Center. Cardiovasc Intervent Radiol. 2016;39:1611–9.CrossRefGoogle Scholar
  13. 13.
    Ma J, Han X, Wu G, Jiao D, Ren K, Bi Y. Outcomes of Temporary Partially Covered Stent Placement for Benign Tracheobronchial Stenosis. Cardiovasc Intervent Radiol. 2016;39:1144–51.CrossRefGoogle Scholar
  14. 14.
    Sahebazamani M, Rubio E, Boyd M. Airway gastric fistula after esophagectomy for esophageal cancer. Ann Thorac Surg. 2012;93:988–90.CrossRefGoogle Scholar
  15. 15.
    Buskens CJ, Hulscher JB, Fockens P, Obertop H, van Lanschot JJ. Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy. Ann Thorac Surg. 2001;72:221–4.CrossRefGoogle Scholar
  16. 16.
    Wang F, Yu H, Zhu MH, Li QP, Ge XX, Nie JJ, et al. Gastrotracheal fistula: treatment with a covered self-expanding Y-shaped metallic stent. World J Gastroenterol. 2015;21:1032–5.CrossRefGoogle Scholar
  17. 17.
    Han XW, Wu G, Li YD, Zhang QX, Guan S, Ma N, et al. Overcoming the delivery limitation: results of an approach to implanting an integrated self-expanding Y-shaped metallic stent in the carina. J Vasc Interv Radiol. 2008;19:742–7.CrossRefGoogle Scholar
  18. 18.
    Bi Y, Chen H, Li J, Fu P, Ren J, Han X, et al. Fluoroscopy-guided removal of individualised airway-covered stents for airway fistulas. Clin Radiol. 2018;73(832):e1–8.Google Scholar
  19. 19.
    Machuzak MS, Santacruz JF, Jaber W, Gildea TR. Malignant tracheal-mediastinal-parenchymal-pleural fistula after chemoradiation plus bevacizumab: management with a Y-silicone stent inside a metallic covered stent. J Bronchology Interv Pulmonol. 2015;22:85–9.CrossRefGoogle Scholar
  20. 20.
    Murgu SD, Colt HG. Silicone Y stent placement at secondary left carina for malignant central airway obstruction. J Thorac Cardiovasc Surg. 2010;139:494–5.CrossRefGoogle Scholar
  21. 21.
    Oki M, Saka H, Kitagawa C, Kogure Y. Silicone y-stent placement on the carina between bronchus to the right upper lobe and bronchus intermedius. Ann Thorac Surg. 2009;87:971–4.CrossRefGoogle Scholar
  22. 22.
    Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J. 2006;27:1258–71.CrossRefGoogle Scholar
  23. 23.
    Oki M, Saka H. New dedicated bifurcated silicone stent placement for stenosis around the primary right carina. Chest. 2013;144:450–5.CrossRefGoogle Scholar
  24. 24.
    Dahlqvist C, Ocak S, d’Odemont JP. New bifurcated silicone stent for the treatment of posttransplant bronchus intermedius stenosis: new silicone stent in posttransplant stenosis. Chest. 2014;145:429.CrossRefGoogle Scholar
  25. 25.
    Lopez-Padilla D, Garcia-Lujan R, de Pablo A, de Miguel Poch E. Oki stenting for anastomotic bronchomalacia in lung transplantation. Eur J Cardiothorac Surg. 2015;48:e53–4.CrossRefGoogle Scholar
  26. 26.
    Oki M, Saka H. Silicone Y-Stent Placement on the Secondary Left Carina. Respiration. 2015;90:493–8.CrossRefGoogle Scholar
  27. 27.
    Ryu YJ, Kim H, Yu CM, Choi JC, Kwon YS, Kim J, et al. Comparison of natural and Dumon airway stents for the management of benign tracheobronchial stenoses. Respirology. 2006;11:748–54.CrossRefGoogle Scholar
  28. 28.
    Bi Y, Yu Z, Ren J, Han X, Wu G. Metallic stent insertion and removal for post-tracheotomy and post-intubation tracheal stenosis. Radiol Med. 2018.  https://doi.org/10.1007/s11547-018-0953-9.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of Interventional RadiologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
  2. 2.Department of Thoracic SurgeryThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina

Personalised recommendations