Indications and interventional options for non-resectable tracheal stenosis

Abstract

Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management.

Keywords: Airway stent; large airway obstruction; laser therapy; rigid bronchoscopy; tracheal stenosis.

Figure 1

Flow volume curves showing upper airway obstruction.

Figure 2

Virtual bronchoscopy images of the normal proximal (A) and distal (B) trachea and tracheal stenosis (C).

Figure 3

The endoscopic images of tracheal stenosis before (A) and after (B) Nd Yag laser therapy.

Figure 4

The technique of Nd Yag laser therapy. The laser fibre is moved in a circumferential fashion, starting from the centre of the airway.

Figure 5

Nd Yag laser therapy. Laser fibre (A) to be inserted through the working channel of the flexible bronchoscope (B), passed through the lumen of the rigid bronchoscope (C). Laser fume extraction device (D), protective curtain (E) and eye wear (F) can be seen.

Figure 6

Tracheal metal stent fracture. Endotracheal view of a fractured covered metal tracheal stent and inset picture demonstrating an expanded metal airway stent.