Management of Benign Dynamic “A-Shape” Tracheal Stenosis: A Retrospective Study of 60 Patients

Abstract

Background. Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management.Methods. Sixty patients with DATS were included. Management decision was made during initial bronchoscopy. When suitable, patients were referred to thoracic surgery for tracheal resection. Posterior localized tracheomalacia was treated with laser photocoagulation of the posterior tracheal wall. Tracheal stents were placed if the stenosis persisted after laser treatment. The choice of stent (straight silicone, hour-glass shaped silicone, Ttube, or fully-covered self-expandable metallic stent) was based on operator's judgment. After 12 to 18 months, stents were removed. If the stenosis persisted after stent removal, surgery was reconsidered. If surgery was not possible, a stent was replaced. In case of satisfactory

Safety and Efficacy of a Fully Covered Self-Expandable Metallic Stent in Benign Airway Stenosis

“…This difference may be of clinical interest in the treatment of tracheal disease, where the largest diameter of silicone stent commercially available may be insufficient, increasing the risk of migration. Our previous work showed a lower risk of migration with Silmet stents than with silicone stents in dynamic A-shape tracheal stenosis, a situation where large tracheal stents are needed [22] . In our experience, certain SEMS, such as Silmet stents, also have less axial stiffness than silicone stents and adapt better to the shape of tortuous airways.…”

Invited Commentary

“…Plojoux and colleagues [1] present their experience with primary endoscopic management of 60 patients with posttracheostomy tracheal stenosis. This particular lesion has been well described as a stomal complication of tracheostomy, with several factors felt to contribute to this complication.…”

Reduktion Tracheostoma-assoziierter Trachealstenosen durch chirurgischen Stomaverschluss

“…Eine plausible Erklärung ist die Entwicklung der Stenose als Resultat der sekundären Wundheilung des Stomas nach der Dekanülierung [10]. Verschiedene Prozesse der Wundheilung, wie die Bildung von Granulationsgewebe, eine Instabilität der Trachealwand sowie eine Kontraktion des Stomakanals resultieren in der Stenose der Trachea [10,11,13] …”