STENTING OF THE TRACHEOBRONCHIAL TREE - 06/09/11

Tracheobronchial obstruction from either benign or malignant disease is a significant cause of morbidity and mortality. Mechanical obstruction of the large airways can cause stridor, severe dyspnea, hypoxemia, or postobstructive pneumonia. Even in the absence of parenchymal disease, ventilatory failure frequently occurs if the obstruction is not relieved. Traditional treatment options have included surgical resection, chemotherapy, and radiation. With advancements in technology, local treatment of tracheobronchial obstructions by bronchoscopy is performed increasingly, with dramatic improvement of symptoms.<sup>12Cavaliere S., Venuta F., Foccoli P., et al. Endoscopic treatment of malignant airway obstructions in 2,008 patients [published erratum of serious dosage error appears in Chest 111:1476, 1997] Chest 1996 ;  110 : 1536 [cross-ref]

Cliquez ici pour aller à la section Références, 51Mehta A.C., Harris R.J., De Boer G.E. Endoscopic management of benign airway stenosis Clin Chest Med 1995 ;  16 : 401

Cliquez ici pour aller à la section Références, 65Petrou M., Goldstraw P. The management of tracheobronchial obstruction: A review of endoscopic techniques Eur J Cardiothorac Surg 1994 ;  8 : 436 [cross-ref]

Cliquez ici pour aller à la section Références</sup>

Tracheobronchial obstructions can result from lesions involving the endobronchial tree or extrabronchial areas. Exophytic endobronchial lesions can be cleared endoscopically by mechanical debulking, laser photoresection, electrocautery, brachytherapy, photodynamic therapy, or cryotherapy. For tracheobronchial obstructions caused by submucosal or extrabronchial lesions, however, endobronchial stent insertion either by itself or in conjunction with the previous options is needed. Factors that influence the selection of a particular treatment modality include the acuity of presentation, the nature of the lesion, and the technical expertise available (Figure 1).