nitinol and Respiratory-Tract-Fistula

The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical self-expandable stent for the treatment of post-pneumonectomy bronchopleural fistula (PPBPF). Between April 2008 and November 2010, six patients underwent treatment for the PPBPF by the introduction of a tracheobronchial conical fully covered self-expandable nitinol stent with the aim of excluding the bronchial dehiscence from the airflow. We secured the prosthesis to the tracheal mucosa with titanium helical fasteners tacks. Five patients presented with a bronchial fistula larger than 5 mm following right (4) or left (1) pneumonectomy. One patient had an anastomotic dehiscence after right tracheal sleeve pneumonectomy. A chest tube showed the absence of empyema in all cases. Immediate resolution of the bronchial air leak was obtained in all the patients. Permanent closure of the bronchial dehiscence without recurrence was achieved in all the patients at a mean follow-up time of 13 months (range 3-32). The bronchial stent was successfully removed in all patients without sequelae 71-123 days after its implantation. The use of the conical self-expandable Silmet(®) stent has proved to be an effective, safe and fast method to treat even large PPBPFs.

Topics: Aged; Alloys; Bronchial Fistula; Bronchoscopy; Device Removal; Feasibility Studies; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumonectomy; Prosthesis Design; Radiography; Reoperation; Respiratory Tract Fistula; Rome; Stents; Time Factors; Treatment Outcome

To assess the efficacy and safety of covered retrievable nitinol stents in oesophageal cancer patients with airway involvement.. Under fluoroscopic guidance, covered retrievable nitinol airway stents were placed in 23 oesophageal cancer patients with airway stricture and/or oesophagorespiratory fistula (ERF) over a long period of 12 years. Six patients only had aspiration by ERF and three patients had both airway stricture and asymptomatic ERF. Technical aspects, dyspnoea improvement, and/or resolution of ERF symptoms, complications, reinterventions, and survival data were evaluated.. A total of 27 airway stents (14 tracheal, 11 bronchial, and two hinged) were placed successfully in 23 patients with airway stricture or ERF. Dyspnoea score decreased significantly after stent placement (p<0.001). ERF were sealed off in all nine patients. Complications included stent migration or expectoration (n=4), haemoptysis (n=2), sputum retention (n=7), and tumour overgrowth (n=1). All three migrated stents were easily removed. Twenty-one patients died, with the median survival period of 76 days (range 2-197 days).. Placement of covered retrievable expandable nitinol stents was safe and effective for the palliative treatment of airway strictures and/or ERF, with a reasonable range of complications, in patients with advanced oesophageal cancer.

Topics: Adult; Aged; Airway Obstruction; Alloys; Bronchi; Bronchography; Device Removal; Epidemiologic Methods; Esophageal Fistula; Esophageal Neoplasms; Female; Fluoroscopy; Foreign-Body Migration; Humans; Male; Middle Aged; Neoplasm Invasiveness; Palliative Care; Radiography, Interventional; Respiratory Tract Fistula; Stents; Tracheal Stenosis; Treatment Outcome

Topics: Adult; Aged; Alloys; Bronchial Fistula; Bronchoscopy; Empyema, Pleural; Female; Humans; Male; Middle Aged; Pleural Diseases; Pneumonectomy; Postoperative Complications; Prosthesis Design; Respiratory Tract Fistula; Treatment Outcome

To evaluate the long-term palliative effect of self-expanding nitinol esophageal stents in patients with malignant dysphagia.. One hundred patients with severe dysphagia secondary to malignant esophageal strictures were treated with self-expanding nitinol stents. The strictures were caused by squamous carcinoma (n = 43), adenocarcinoma (n = 28), anastomotic tumor recurrence (n = 14), and mediastinal tumor (n = 15).. One hundred six stents were successfully positioned in 100 patients. Attempts to insert a second, coaxial stent were unsuccessful in two patients; a second stent was placed incorrectly in another patient. Statistically significant (P < .001) reduction of dysphagia was noted after expansion of the stents. Complications consisted of incomplete expansion secondary to stent twisting (n = 4), stent migration (n = 4), tumor ingrowth (n = 17), tumor overgrowth (n = 3), food impaction (n = 5), fracture of stent wires (n = 2), benign strictures at stent edges (n = 2), tumor bleeding (n = 3), and esophagorespiratory fistula (n = 5). The primary patency rate was 75% (77 of 102 stents); the secondary patency rate was 94% (96 of 102 stents). The survival time (mean, 6.2 months; range, 0.1-47 months) varied with the diagnosis.. Placement of self-expanding nitinol stents is safe and has a good long-term palliative effect on dysphagia in patients with malignant esophageal strictures.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Alloys; Anastomosis, Surgical; Carcinoma, Squamous Cell; Deglutition Disorders; Equipment Design; Equipment Failure; Esophageal Fistula; Esophageal Neoplasms; Esophageal Stenosis; Evaluation Studies as Topic; Female; Follow-Up Studies; Food; Foreign-Body Migration; Hemorrhage; Humans; Longitudinal Studies; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Palliative Care; Respiratory Tract Fistula; Stents; Surface Properties; Survival Rate