Principles and Practice of Interventional Pulmonology by Armin Ernst & Felix JF Herth

Author:Armin Ernst & Felix JF Herth
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Outcomes

Initial outcomes are excellent (Fig. 38.5) with long-term success requiring repeat procedures at times. Complications are rare (Table 38.3) and typically mild and self-limited. In a small series, Sheski and his colleague had success with an initial procedure in 10 of 14 patients. Adjunct procedures, such as stenting or cryotherapy, and multiple procedures – up to 30 in an extreme case – were required in others. Hebra in a series in children showed a 90% initial and 54% long-term success in tracheal dilation with an average of four sessions. Ferretti, using 1–5 repeat sessions, had a 68% initial success and a 56% long-term success. The lower initial success might be explained by the dilation of some malacia patients in the group. A larger series was reported by Hautmann and colleagues in malignant stenoses and showed better diameter in 79% of stenoses with one procedure, reaching the intended outcome of symptom relief or stenting. Stenting in this case served as an adjunct to other interventions or to lead to better tolerance of other interventions. Most interestingly, Kim and colleagues showed that for benign stenosis patients, laceration of the airway was associated with longer term airway patency. They found that approximately half of dilations led to some degree of airway laceration with the vast majority of these superficial. Few were deep, and none were through and through. Some tears had associated mild chest pain, blood-tinged sputum, or even pneumomediastinum, but these all resolved spontaneously at 24 h The tears themselves healed spontaneously in 1 month when superficial and up to 9 months when deep. All were managed conservatively. Patient with tears had an average of 24 months of patency as compared to 4 months for those without a tear. The caveat is that the main etiology of these stenoses was tuberculosis, and the responsiveness or stiffness of the tissue in post tuberculosis stenosis may not apply to all causes.

Fig. 38.5Tracheal stenosis. Before (a), during (b), and after (c) balloon dilation

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