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Correspondence

Should Ultraflex Metallic Stents Be Used In Benign Airway Obstruction?

Department of Thoracic and Cardiovascular Surgery, Aristotle University of Thessaloniki Medical School, AHEPA University Hospital, 1 Stilponos Kiriakidi Street, Thessaloniki 54636, Greece

(Email: cforoulis{at}otenet.gr).

To the Editor:

We read with interest the article by Husain and colleagues [1] on long-term follow-up of Ultraflex metallic stents (Boston Scientific Corp, Watertown, MA), especially those inserted in 12 cases of benign central airway obstruction. Twice, we recently dealt with late complications of covered Ultraflex metallic stents (Boston Scientific Corp) that were inserted in the past for post-intubation tracheal stenosis. Late airway obstruction due to obstructing granuloma formation at both ends of the stent developed in 2 patients. Both patients had a 3-year asymptomatic period after stent insertion. In the first patient, a Montgomery T-tube (Hood Laboratories, Pembroke, MA) was inserted to control the airway by cutting the stent at the tracheotomy site. In the second patient, the attempt to destruct the obstructing granuloma with neodymium:yttrium-aluminum-garnet laser resulted in flaming of the stent and tracheal wall and prolonged intensive care unit stay.

We believe that the use of any kind of metallic airway stent, either covered or uncovered, should be limited for patients with malignant airway obstructions, based on our recent experience with late tracheal obstruction and the public health notification of the Food and Drug Administration (FDA) in 2005 concerning complications of metallic airway stents in patients with benign airway disorders [2]. Easy insertion and release of the Ultraflex stent through flexible and rigid bronchoscopes does not justify their routine use for benign conditions, because they are associated with serious complications. The FDA notification reports obstructive granulation tissue inside an uncovered stent, stenosis at the end of the stent, migration of the stent, mucous plugging, infection, and stent fracture [2, 3]. In addition, the use of these stents may preclude patients from receiving other alternative therapies in the future, such as surgical resection and reconstruction of the trachea or placement of a silicone stent [2–4]. Removal of a metallic stent 2 weeks after insertion may result in serious complications, such as mucosal tears, severe bleeding, obstruction of the airway and respiratory failure, and tension pneumothorax. Piece-meal resection of a metallic stent may lead to permanent incorporation of retained stent fragments into the tracheal wall [2, 3]. Laser destruction of the granuloma at the end of a covered polyurethane stent needs an experienced surgeon, because of the danger of tracheal wall flaming. With respect to the encouraging experience of Husain and colleagues with the use of Ultraflex metallic stents in benign airway obstruction [1], we have to report our recent experience of granulation tissue formation at the end of two Ultraflex metallic tracheal stents that had as result late tracheal obstruction, and to advise caution with the use of metallic stents in benign airway obstruction.

	References

Top References

 

1. Husain SA, Finch D, Ahmed M, Morgan A, Hetzel MR. Long-term follow-up of Ultraflex metallic stents in benign and malignant central airway obstruction Ann Thorac Surg 2007;83:1251-1256.[Abstract/Free Full Text]
2. FDA Public Health Notification: Complications from metallic tracheal stents in patients with benign airway obstruction. Available at: http://www.fda.gov/cdrh/safety/072905-tracheal.html. Accessed March 28, 2008.
3. Madden BP, Loke TK, Sheth AC. Do expandable metallic airway stents have a role in the management of patients with benign tracheobronchial disease? Ann Thorac Surg 2006;82:247-248.
4. Saad CP, Murthy S, Krizmanich G, Mehta AC. Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis Chest 2003;124:1993-1999.[Medline]

This article has been cited by other articles:

				S. A. Husain, A. Morgan, and M. Hetzel Reply Ann. Thorac. Surg., May 1, 2008; 85(5): 1843 - 1843. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Christophoros N. Foroulis Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Foroulis, C. N. Articles by Papakonstantinou, C. Search for Related Content PubMed PubMed Citation Articles by Foroulis, C. N. Articles by Papakonstantinou, C. Related Collections Trachea and bronchi Related Article