Abstract
Purpose
To evaluate the clinical efficacy and safety of radiologic management for the treatment of benign tracheal strictures caused by tracheostomy.
Materials and Methods
We retrospectively reviewed of 13 patients with benign tracheal stricture caused by tracheostomy that was treated with balloon dilation or stent placement. Balloon dilation had initially been performed. Stent placement was indicated in patients who showed a poor response to balloon dilation. Outcomes were assessed according to the following variables: technical and clinical success, Hugh–Jones classification scale before and after the procedures, and complications.
Results
Balloon dilation and stent placement were technically successful in all patients. Nine of the 13 patients (69 %) showed no response to balloon dilation, and the remaining the four patients showed a positive response to initial balloon dilation. Six of the nine (67 %) patients showed a good response to temporary stent placement and required no further treatment. Mean Hugh–Jones grades improved from 3.6 ± 0.8 to 1.8 ± 1.1 (P < 0.001). During a follow-up period of 2.6–40.8 months (mean 16.5), overall clinical success was achieved in 10 patients (77 %) after a single balloon dilation (n = 4) and temporary stent placement (n = 6). The remaining three patients with clinical failure underwent tracheal resection (n = 3).
Conclusion
Radiologic management can be a safe and effective therapeutic option for treating benign tracheal stricture caused by tracheostomy. Temporary stent placement can be effective in patients with symptoms recurring soon after balloon dilation.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Wain JC (2003) Postintubation tracheal stenosis. Chest Surg Clin N Am 13(2):231–246
Grillo HC, Donahue DM (1996) Post intubation tracheal stenosis. Semin Thorac Cardiovasc Surg 8(4):370–380
Tsakiridis K, Darwiche K, Visouli AN et al (2012) Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents in patients with failed or contraindicated surgical reconstruction of trachea. J Thorac Dis 4(1):32–40
Carretta A, Casiraghi M, Melloni G et al (2009) Montgomery T-tube placement in the treatment of benign tracheal lesions. Eur J Cardiothorac Surg 36(2):352–356
Saghebi SR, Zangi M, Tajali T et al (2009) The role of T-tubes in the management of airway stenosis. Eur J Cardiothorac Surg 43(5):934–939
Dumon JF, Rebound E, Garbe L, Aucomte F, Meric B (1982) Treatment of tracheobronchial lesions by laser photoresection. Chest 81(3):278–284
Song HY, Shim TS, Kang SG et al (1999) Tracheobronchial strictures: treatment with a polyurethane-covered retrievable expandable nitinol stent—initial experience. Radiology 213(3):905–912
Shin JH, Kim SW, Shim TS et al (2003) Malignant tracheobronchial strictures: palliation with covered retrievable expandable nitinol stent. J Vasc Interv Radiol 14(12):1525–1534
Kim JH, Shin JH, Song HY, Shim TS, Yoon CJ, Ko GY (2007) Benign tracheobronchial strictures: long-term results and factors affecting airway patency after temporary stent placement. Am J Roentgenol 188(4):1033–1038
Kim JH, Shin JH, Song HY et al (2010) Cutting balloon treatment for resistant benign bronchial strictures: report of eleven patients. J Vasc Interv Radiol 21(5):748–752
Kim JH, Shin JH, Shim TS et al (2004) Efficacy and safety of a retrieval hook for removal of retrievable expandable tracheobronchial stents. J Vasc Interv Radiol 15(7):697–705
Thornton RH, Gordon RL, Kerlan RK et al (2006) Outcomes of tracheobronchial stent placement for benign disease. Radiology 240(1):273–282
Gildea TR, Murthy SC, Sahoo D, Mason DP, Mehta AC (2006) Performance of a self-expanding silicone stent in palliation of benign airway conditions. Chest 130(5):1419–1423
Kim JH, Shin JH, Song HY et al (2007) Tracheobronchial laceration after balloon dilation for benign strictures: incidence and clinical significance. Chest 131(4):1114–1117
Lee WH, Kim JH, Park JH (2013) Fluoroscopically guided balloon dilation for postintubation tracheal stenosis. Cardiovasc Interv Radiol. doi:10.1007/s00270-013-0556-8
Epstein SK (2005) Late complications of tracheostomy. Respir Care 50(4):542–549
Myers EN, Carrau RL (1991) Early complications of tracheotomy: incidence and management. Clin Chest Med 12(3):589–595
Streitz JM Jr, Shapshay SM (1991) Airway injury after tracheotomy and endotracheal intubation. Surg Clin N Am 71(6):1211–1230
Puma F, Ragusa M, Avenia N et al (2000) The role of silicone stents in the treatment of cicatricial tracheal stenoses. J Thorac Cardiovasc Surg 120(6):1064–1069
Lim SY, Kim H, Jeon K et al (2012) Prognostic factors for endotracheal silicone stenting in the management of inoperable post-intubation tracheal stenosis. Yonsei Med J 53(3):565–570
Zias N, Chroneou A, Tabba MK et al (2008) Post tracheostomy and post intubation tracheal stenosis: report of 31 cases and review of the literature. BMC Pulm Med 21(8):18
Mehta AC, Lee FY, Cordasco EM, Kirby T, Eliachar I, De Boer G (1993) Concentric tracheal and subglottic stenosis. Management using the Nd–YAG laser for mucosal sparing followed by gentle dilatation. Chest 104(3):673–677
Ferretti G, Jouvan FB, Thony F, Pison C, Coulomb M (1995) Benign noninflammatory bronchial stenosis: treatment with balloon dilation. Radiology 196(3):831–834
Carre P, Rousseau H, Lombart L et al (1994) Balloon dilatation and self-expanding metal Wallstent insertion for management of bronchostenosis following lung transplantation: the Toulouse Lung Transplantation Group. Chest 105(2):343–348
Lee KH, Ko GY, Song HY, Shim TS, Kim WS (2002) Benign tracheobronchial stenoses: long-term clinical experience with balloon dilation. J Vasc Interv Radiol 13(9):909–914
Iwamoto Y, Miyazawa T, Kurimoto N et al (2004) Radiological bronchoscopy in the management of airway stenosis due to tracheobronchial tuberculosis. Chest 126(4):1344–1352
Gaissert HA, Grillo HC, Wright CD, Donahue DM, Wain JC, Mathisen DJ (2003) Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 126(3):744–747
Lunn W, Kopman DF, Wahidi M, Ahiku S, Thurer R, Ernst A (2005) Endoscopic removal of metallic airway stents. Chest 127(6):2106–2112
Conflicts of interest
All authors have no conflicts of interest and nothing to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Park, JH., Kim, J.H., Song, HY. et al. Management of Benign Tracheal Strictures Caused by Tracheostomy . Cardiovasc Intervent Radiol 37, 743–749 (2014). https://doi.org/10.1007/s00270-013-0727-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-013-0727-7