Endobronchial interventions including the deployment of endobronchial stents have a clear role in the management of central airway problems. The use of endobronchial stents has rapidly increased since the first airway stent was developed in the 1960s and with the subsequent manufacture of improved silicone and metallic stents. They provide effective relief for symptoms of intrinsic and extrinsic airway obstruction secondary to a wide range of pathologies including lung cancer, lymphoma, thyroid carcinoma and benign disease such as tracheal strictures and tracheobronchomalacia. Endobronchial stents can also seal defects within the airway including malignant broncho-oesophageal fistulae and posterior wall tracheal tears. They can be placed safely under conscious sedation at flexible bronchoscopy or under general anaesthetic at rigid bronchoscopy. Rigid bronchoscopy under general anaesthesia provided by a multidisciplinary team is safe with few contraindications. Complications of endobronchial stents include infection, granulation tissue formation and metallic stent fracture sometimes requiring removal, although serious life-threatening complications are very rare. Increasing numbers of patients are being referred to specialist centres for airway intervention. This article reviews the history of endobronchial stents, the different stents available, and the indications, outcomes and complications involved in deploying endobronchial stents.
was performed. We do not routinely use ultrasound guidance or stop anticoagulation. Operators with a median experience of 450 procedures performed the RHCs. Results: Right heart catheterization was performed on 349 patients with a median age of 66 years (range, 17-89), median mean pulmonary artery pressure of 30 mm Hg (range, 8-69), and a median internationalized normal ratio of 2.5. Of 349 patients, we were unable to obtain intravenous access in only 1 patient; 342 (98%) patients tolerated RHC with local anesthetic alone; and 6 patients required additional sedation with benzodiazepines. The median time for the procedure was 15 minutes. Complications occurred in 6 patients (1.7%) and included carotid puncture (n = 3), sinus bradycardia below 45 beats/min, which responded promptly to atropine and intravenous fluid (n = 2), and complete heart block without hemodynamic compromise (n = 1). There were no pneumothoraxes, pulmonary hemorrhage, or deaths related to the procedure. Conclusion: Right heart catheterization via the IJV is quick, safe, and well tolerated. It is not associated with an increased risk of pneumothorax or other complications when performed by experienced operators.
IntroductionRight heart catheterization (RHC) using a pulmonary artery catheter (PAC) remains the gold standard in the diagnosis of pulmonary arterial hypertension (PAH). In addition to diagnosing PAH and assessing for potential reversibility, it can ascertain whether pulmonary hypertension (PH) is due to cardiac disease and can guide therapeutic intervention. Measurement of pulmonary hemodynamics is also required in patients being considered for cardiothoracic, and occasionally hepatic, transplantation. A percutaneous femoral vein approach is more commonly used in some centers. Less commonly, an internal jugular vein (IJV) approach is used which may reflect concerns regarding risks associated with this site of access. We describe our experience of RHC performed via the IJV at a tertiary center for cardiothoracic medicine.
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