Tracheal A‐Frame Deformities Following Airway Reconstruction

Abstract

Objectives: Airway reconstruction for subglottic and tracheal stenosis is often successful in achieving tracheostomy decannulation and improving airway symptoms. However, one common reason for late failure is development of a tracheal A-frame deformity, which can necessitate additional surgery. Although knowledge of this deformity exists, the incidence and risk factors have not been reported. This study seeks to determine the incidence of A-frame following airway reconstruction and define factors that correlate with development of this deformity. Study Design: Retrospective case series. Methods: Patients under 21 years of age undergoing open airway reconstruction at our institution between January 2005-December 2006 were retrospectively reviewed. Demographic data, comorbidities, airway history/reconstruction type, and follow-up airway findings were examined using multivariable logistic regression. Kaplan-Meier curves were used to examine time to A-frame repair. Results: Two hundred patients underwent airway reconstruction and 69 (34.5%) developed an A-frame deformity. History of tracheostomy was the most significant contributor to A-frame development (P < .0001). Double-versus single-stage procedures were not associated with increased odds of A-frame development (P = .94), however, patients undergoing resection procedures as opposed to laryngotracheal reconstruction (LTR) with cartilage grafts had a significantly lower chance of developing this deformity (P = .004). Of the patients with an A-frame, 27 (39%) required further surgical intervention. Conclusion: Approximately one-third of patients undergoing airway reconstruction developed a tracheal A-frame deformity, with a significantly higher rate among patients with a history of tracheostomy and those undergoing LTR. Patients should be followed long term to assess for the development of an A-frame.

Association between surgical tracheostomy and chronic tracheal stenosis: A retrospective, single-center study

“…In the localization of tracheal stenosis, the minimum tracheal area was seen at the proximal and distal locations at BL, where there might be difficulty with intubation, even in patients without stenosis. After tracheostomy, the minimum tracheal area was predominantly observed above the tracheostomy site, consistent with prior reports examining symptomatic tracheal stenosis or deformity by endoscopy (6,12). On the other hand, the maximum area was broadly distributed across the trachea at BL.…”

“…The benefits of tracheostomy include upper airway management, as well as decreased risk of ventilator-associated pneumonia in patients intubated longterm (2,3). However, a tracheostomy can alter the tracheal shape around the surgical site to result in an A-frame or triangularshaped deformity (4)(5)(6), which can lead to tracheal stenosis (7). Tracheal stenosis of > 30% to 50% of the original size is thought to cause respiratory symptoms, and the incidence of symptomatic tracheal stenosis after tracheostomy is reported to be 1 to 6% (7)(8)(9).…”

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

“…Tracheal A‐frame deformity can be a challenge for anesthesiologist when they are not expecting such obstruction 8,9 . Patients with shortness of breath and history of tracheostomy should increase the awareness of the possibly of an A‐frame deformity.…”

“…1). 4–9 When impacting day‐to‐day life, tracheal resection with end‐to‐end anastomosis is the conventional treatment, boasting a high success rate 5 ; however, the open procedures require prolonged anesthetic and recovery time. Nouraei and Sandhu reported a series of 40 adults with tracheal A‐frame deformities managed with staged endoscopic CO 2 laser resection; 30 (75%) achieved a good dyspnea outcome, and two who had a tracheostomy in place initially were decannulated after endoscopic A‐frame resection 4 .…”

Three-dimensional bioprinting and electrospinning of cellulose nanocrystal/polycaprolactone for tracheal scaffolds

“…Accidental injuries, industrial accidents, cancer, idiopathic diseases, congenital anomalies, and medical diseases can damage trachea tissue Huang et al 2021). In this context, rapid reconstruction of a patient's airway is important in clinical practice (Kennedy et al 2021). When a trachea stenosis lesion occurs, the surgeon removes the diseased stenotic segment of the trachea and pulls down the remaining proximal and distal segments to secure the anastomosis.…”