Interventional Therapies for Central Airways

Abstract

Central airway obstruction (CAO) is a dangerous and increasingly common problem. CAO refers to lesions causing narrowing of the trachea or mainstem bronchi and is generally divided into malignant and nonmalignant categories. These 2 entities may be caused by a variety of thoracic and extrathoracic diseases. Imaging is critical during the initial assessment of CAO and may help thoracic physicians focus the differential diagnosis and plan the safest and most appropriate diagnostic and therapeutic interventions. However, direct visualization via flexible or rigid bronchoscopy is often necessary for diagnostic and treatment purposes. A large number of procedures can be performed through bronchoscopy, with the goal of relieving the obstruction and improving patency of the airway. Deciding which procedure to perform is based both upon the type of lesion and whether the lesion is due to a malignant or nonmalignant process. Possible interventions include mechanical debridement, laser therapy, argon plasma coagulation, electrocautery, brachytherapy, and stent placement. Immediate postoperative and follow-up imaging is crucial to monitor for immediate, subacute, and chronic complications as well as disease progression and recurrence.

Central airway obstruction: is it time to move forward?

“…Interventional bronchoscopy options include the use of both rigid and flexible bronchoscopy. Both have advantages in different scenarios and should be seen as complimentary procedures [ 62 , 68 ]. Guidelines do not favour rigid over flexible bronchoscopy, although the procedure with rigid bronchoscopy is considered safer.…”

“…It is exclusively used for endobronchial lesions and may require repeated procedures. Rigid bronchoscope debulking of lesions and scar tissue is also simple, effective and accomplished by suction under direct telescopic guidance [ 62 , 68 ].…”

“…For patients with primary lung cancer which develop CAO, besides all interventional bronchoscopy techniques mention above, in some cases, additional stenting is required [ 68 ]. Airway stents are tube-shaped devices that are inserted into the airway to maintain patency.…”

Migration of ingested sharp foreign body into the bronchus: a case report and review of the literature

“…Advances in bronchoscope, such as laser technology, have broadened the therapeutic options. For adults, laser therapy is mainly applied in the treatment of airway tumors, bronchial stones and so on [19]. In the pediatric field, its most common indication is granuloma clearance before tracheal fistula removal [20].…”

Faktoren für die Langzeitprognose des klinischen Erfolgs nach interventioneller Bronchoskopie bei Patienten mit narbiger zentraler Atemwegsstenose

“…Bei den meisten unserer Fälle wurde eine Kombination von Modalitäten eingesetzt. Berichten zufolge verursacht die Thermotherapie im Vergleich zur mechanischen Dilatation und Kryotherapie ein starkes Wachstum von Granulationsgewebe und Knorpelschäden [35, 36, 37, 38]. Aus diesem Grund haben wir die Anwendung dieser Modalität, wenn möglich, vermieden, um die Schädigung der Atemwege möglichst gering zu halten.…”