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Vol. 41. Issue 6.
Pages 322-327 (June 2005)
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Vol. 41. Issue 6.
Pages 322-327 (June 2005)
Original Articles
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Endoscopic Treatment of Central Airway Stenosis: Five Years' Experience
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A. Cosano Povedano, L. Muñoz Cabrera, F.J. Cosano Povedano
Corresponding author
andr539@separ.es

Correspondence: Dr. A. Cosano Povedano. Servicio de Neumología. Hospital Universitario Reina Sofía. Avda. Menéndez Pidal, s/n. 14004 Córdoba. España
, J. Rubio Sánchez, N. Pascual Martínez, A. Escribano Dueñas
Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Objective

TO describe our experience with interventional bronchoscopy in the treatment of central airway stenosis.

Patients and methods

We reviewed patient records and bronchoscopic findings. Clinical data, findings from computed tomography, techniques performed, complications, and results were recorded.

Results

One-hundred and thirty-six patients (90 males and 46 females) were treated. The mean (SD) age was 57 (7) years (range, 3-81). A total of 320 therapeutic interventions were performed: 145 laser treatments, 33 balloon or mechanical dilatations, 26 electrocauterizations, and 116 stent insertions. Pathogenesis varied: in 64 (47%) patients, the stenosis was caused by a tumor (48 were bronchopulmonary and 16 nonpulmonary); in 72 (53%) patients, stenosis was secondary to a nontumor-related process, of which the most common was prolonged intubation (42% of these cases). Central airway patency was achieved in 92% (59/64) of the tumor-related stenoses and 96% (69/72) of those unrelated to tumors. Improvement in dyspnea was observed in 96% of all patients. Two deaths (due to hemoptysis and to acute myocardial infarction) occurred in the first week, for a 1.4% mortality rate. The most common complications were stent migration (8%; 9/116 cases) and the formation of granulomas (9%; 11/116).

Conclusions

Interventional bronchoscopy is an effective technique to resolve life-threatening obstructions of the central airways. Dyspnea improves immediately and there is no significant morbidity or mortality.

Key words:
Airways
Interventional bronchoscopy
Stents
Objetivo

Describir nuestra experiencia en estenosis de la vía aérea principal (VAP) tratadas mediante broncoscopia intervencionista.

Pacientes y métodos

Se han revisado las historias clíni-cas e informes de broncoscopia y se han registrado los datos clínicos, informe de tomografía axial computarizada, técnicas realizadas, complicaciones y resultados.

Resultados

Se trató a 136 pacientes (90 varones y 46 mujeres), con una edad media ± desviación estándar de 57 ± 7 años (rango: 3-81), en quienes se realizaron 320 procedimientos terapéuticos, que incluyeron 145 tratamientos con láser, 33 dilataciones con balón o mecánicas, 26 tratamientos mediante electrocauterio y la colocación de 116 prótesis. La etiología de la estenosis fue diversa: hubo 64 (47%) de causa tumoral (48 de origen broncopulmonar y 16 tumores extrapulmonares), mientras que en 72 pacientes (53%) la estenosis fue secundaria a una enfermedad no tumoral; de éstas, la causada por intubación prolongada fue la más frecuente (el 42% de los casos).

La permeabilidad de la VAP se logró en el 92% (59/64) de las estenosis de etiología tumoral y en el 96 % de las no tumorales (69/72), y se observó mejoría de la disnea en el 96% de todos los pacientes. En la primera semana hubo 2 fallecimientos (por hemoptisis e infarto agudo de miocardio), lo que representa una mortalidad del 1,4%. Las complicaciones más frecuentes fueron la migración de prótesis en un 8% (9/116) y en un 9% la formación de granulomas (11/116).

Conclusiones

La broncoscopia intervencionista es una técnica eficaz para resolver las situaciones de riesgo vital de la VAP, con mejoría inmediata de la disnea y sin morbimortalidad significativa.

Palabras clave:
Vías aéreas
Broncoscopia intervencionista
Prótesis
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REFERENCES
[1]
P Díaz Jiménez, AN Rodríguez.
Broncoscopia rígida.
Neumología intervencionista, pp. 1-18
[2]
LM Seijo, DH Sterman.
Interventional pulmonology.
N Engl J Med, 344 (2001), pp. 740-748
[3]
PL Boelcskei, R Dierkesmann, PC Bauer, HD Becker, CT Bolliger, FJ Wolfgang.
Section on respiratory endoscopy of the German Society of Pulmonology. Recommendations for bronchoscopic treatment of tracheobronchial occlusions, stenoses, and mural malignant tumors.
J Bronchol, 7 (2000), pp. 133-138
[4]
KE Stephens, DE Wood.
Bronchoscopic management of central airway obstruction.
J Torac Cardiovasc Surg, 119 (2000), pp. 289-296
[5]
Martínez-Ballarín, JP Díaz-Jiménez, MJ Castro, JA Moya.
Silicone stents in the management of benign tracheobronchial stenoses. Tolerance and early results in 63 patients.
Chest, 109 (1996), pp. 626-629
[6]
JM Rubio Sánchez, N Feu Collado, N Pascual Martínez, A Escribano Dueña, B Jurado Gámez, JC Bioque Ribera, et al.
Tratamiento endobronquial de las estenosis benignas de las vías aéreas.
Neumosur, 14 (2002), pp. 177-183
[7]
A Vonk-Noordegraaf, PE Postmus, TG Sutedja.
Tracheobronchial stenting in the terminal care of cancer patients with central airways obstruction.
Chest, 120 (2001), pp. 1811-1814
[8]
A Ernst, GA Silvestri, D Johnstone.
Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians.
Chest, 123 (2003), pp. 1693-1717
[9]
ID Conacher.
Anaesthesia and tracheobronchial stenting for central airway obstruction in adults.
Br J Anaesth, 90 (2003), pp. 367-374
[10]
A d'Aloia, P Faggiano, C Fiorina, E Vizzardi, S Cavaliere, P Foccoli, et al.
Cardiac arrest due to ventricular fibrillation as a complication occurring during rigid bronchoscopic laser therapy.
Monaldi Arch Chest Dis, 59 (2003), pp. 88-90
[11]
J Strausz.
Management of postintubation tracheal stenosis with stent implantation.
J Bronchol, 4 (1997), pp. 294-296
[12]
H Hoppe, HP Dintel, B Walter, G von Allmen, M Gugger, P Vock.
Grading airway stenosis down to the segmental level using virtual bronchoscopy.
Chest, 125 (2004), pp. 704-711
[13]
GR Ferretti, M Kocier, O Calaque, F Arbib, C Righini, M Coulomb, et al.
Follow-up after stent insertion in the tracheobronchial tree: role of helical computed tomography in comparison with fiberoptic bronchoscopy.
Eur Radiol, 13 (2003), pp. 1172-1178
[14]
A Álvarez, J Algar, F Santos, R Lama, JL Aranda, C Baamonde, et al.
Airway complications after lung transplantation: a review of 151 anastomoses.
Eur J Cardiothorac Surg, 19 (2001), pp. 381-387
[15]
ME Halkos, KD Godette, EC Lawrence, JI Millar.
High dose rate brachytherapy in the management of lung transplant airway stenosis.
Ann Thorac Surg, 76 (2003), pp. 381-384
[16]
PN Chajed, MA Malouf, M Tamm, P Spratt, AR Glanville.
Interventional bronchoscopy for the management of airway complications following lung transplantation.
Chest, 120 (2001), pp. 1894-1899
[17]
PN Chajed, MA Malouf, M Tamm.
Ultraflex stent for the management of airway complications in lung transplant recipients.
Respirology, 8 (2002), pp. 59-64
[18]
HJ Schafers, CM Schafer, C Zink, A Haverich, HG Borst.
Surgical treatment of airway complications after lung transplantation.
J Thorac Cardiovasc Surg, 107 (1994), pp. 1476-1480
[19]
S Cavaliere, P Foccoli, C Toninelli, S Feijo.
Laser in lung cancer. An 11-year experience with 2253 applications in 1585 patients.
J Bronchol, 1 (1994), pp. 105-111
[20]
U Prakash.
Bronchoscopic resection of surgically resectable tracheobronchial neoplasms.
J Bronchol, 3 (1996), pp. 85-87
[21]
KP Wang, JF Turner.
YAG laser resection of hamartoma.
J Bronchol, 3 (1996), pp. 112-115
[22]
TJ van Boxem, BJ Venmans, PE Postmus, TM Sutedja.
Endo-bronchial electrocautery: a review.
J Bronchol, 2 (2000), pp. 166-170
[23]
JF Dumon, S Cavaliere, JP Díaz-Jiménez, JM Vergnon, F Venuta, JF Dumon, et al.
Seven-year experience with the Dumon prosthesis.
J Bronchol, 3 (1996), pp. 6-10
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