Endobronchial treatment of airway obstruction – 100 cases

Introduction

Tracheobronchial disobstruction is a method to make the airway patent and offer a better quality of life to the patient. Starting in 1997, the bronchoscopy service of Hospital Enrique Tornú performed the first endosurgical treatments to reconstruct the tracheal and bronchial lumen, using stents.

Occlusive and subocclusive lesions, of benign or malignant nature, of the trachea and/or bronchi were treated in 100 patients. All of them had been excluded from conventional open surgery because of the anatomical characteristics of their lesions or due to the advanced stage of their disease.

The airway disobstruction procedures were carried out with:

1. High-frequency electrosurgical unit
2. Mechanical dilation
3. Prosthesis implantation

Indications

Neoplastic conditions or their consequences

• Tracheobronchial neoplasms
• Extrinsic compression or submucosal involvement
• Following laser photoresection, cryotherapy or electrocautery, to keep the airway open
• Tracheobronchoesophageal fistula (together with an esophageal stent)

Benign conditions

• Bronchial stenoses secondary to end-to-end anastomoses or lung transplantation
• Post-traumatic (post-intubation)
• Post-infectious (endobronchial tuberculosis, histoplasmosis with mediastinal fibrosis, herpes virus, diphtheria, opportunistic infections in immunocompromised patients)
• Tracheobronchomalacia: focal, following tracheostomy or radiation therapy; or diffuse: idiopathic, polychondritis or Mounier-Kuhn syndrome
• Tracheal or bronchial tumors: papillomatosis, amyloidosis
• Post-inflammatory (Wegener's disease)

Miscellaneous

• Extrinsic compression by aortic aneurysm
• Tracheal distortion due to kyphoscoliosis
• Tracheal obstruction by an esophageal stent

Contraindications

• There are no contraindications in an emergency
• Laryngeal conditions that prevent tracheal intubation with a rigid bronchoscope
• Tracheostomy

Complications

• Hemorrhage
• Combustion
• Perforation of the airway wall
• Encrustation of secretions
• Migration of the prosthesis
• Colonization of the stent

Material and method

Of the 100 patients treated, 40 suffered from airway obstruction of benign etiology and 60 due to neoplastic conditions or their consequences.

The tracheobronchial recanalization treatment required the use of 86 silicone prostheses to ensure ventilation.

Results

In the cases with benign stenosis, recovery of the airway lumen was achieved in all of them. One patient died at 6 weeks from staphylococcal pneumonia.

Of the 60 patients with neoplastic disease, 55 (92%) recovered ventilation of the affected area, with symptomatic improvement, and followed the course of their underlying pathology. In the remaining 5 (8%), disobstruction was not possible due to infiltrating endoluminal and intramural lesions. Intense hemorrhage was a complication that forced the interruption of the procedure in one case.

Conclusions

Recovery of the airway lumen produces immediate relief for the patient with benign stenosis. In cases with neoplastic disease that have been excluded from open surgical resection, endoscopic recanalization offers the possibility of better survival and wards off immediate complications.

One hundred patients with tracheal or bronchial obstruction of benign or malignant nature were treated with a radiofrequency electrosurgical unit and/or mechanical dilation, with the implantation of 86 silicone prostheses, recovering airway function in 95%.

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