ABSTRACT
We describe a case series of 35 patients with either benign (14) or malignant (21) tracheal stenosis who were treated using a novel silicone stent, the HCPA-1, designed to prevent migration. Between March 2001 and September 2008, 13 women and 22 men received 41 HCPA-1 stents. The median duration of stenting in benign cases was 457 days (range, 4-2,961 days). Successful stent removal with curative results was accomplished in 2 patients with tracheomalacia and 1 with post-intubation stenosis. In malignant cases, the median duration of stenting was 162 days (range, 1-1,279 days). Five patients had tumor progression with obstruction requiring repeated laser resection, dilatation, or additional stents. Two patients died due to airway obstruction despite bronchoscopic intervention. Twelve patients with malignant lesions died with the stent in place. At the end of the study, 3 patients with malignant disease remained alive; 2 were lost to follow-up. The HCPA-1 stent proved to be safe, with no severe complications during the study period, and effective in improving quality of life with relief of dyspnea.
Subject(s)
Airway Obstruction/therapy , Bronchial Diseases/therapy , Bronchoscopy/instrumentation , Silicones , Stents , Tracheal Stenosis/therapy , Adult , Aged , Airway Obstruction/diagnostic imaging , Airway Obstruction/etiology , Airway Obstruction/mortality , Brazil , Bronchial Diseases/diagnostic imaging , Bronchial Diseases/mortality , Bronchoscopy/adverse effects , Catheterization , Chi-Square Distribution , Device Removal , Dyspnea/etiology , Dyspnea/therapy , Female , Humans , Intubation, Intratracheal/adverse effects , Kaplan-Meier Estimate , Male , Middle Aged , Neoplasms/complications , Palliative Care , Proportional Hazards Models , Prosthesis Design , Radiography , Time Factors , Tracheal Stenosis/diagnostic imaging , Tracheal Stenosis/etiology , Tracheal Stenosis/mortality , Tracheomalacia/complications , Tracheostomy/adverse effects , Treatment OutcomeABSTRACT
The objective of the following study was to evaluate antigenicity, malacia and revascularization in glycerin-preserved canine tracheal allografts. Trachea with six cartilage rings (2.4 to 3.1 cm) were distributed in three study groups: autograft (21), allograft (18) and glycerin-preserved (22). We implanted two segments from different groups in the greater omentum of dogs. After 28 days, latex was injected in the canine aorta before the segments were harvested. We evaluated number of sectors with functional vessels, number of vessels dyed in the submucosa, acute arteritis score, incidence of acute rejection, cartilage lesion score, and malacia. The autograft group had a larger number of dyed vessels than the glycerin-preserved group. The autograft group also had a higher average number of quadrants with functional vessels than the allograft group and the glycerin-preserved group. The allograft group had a higher mean score for acute arteritis than the autograft group and more acute rejection than the glycerin-preserved group. The cartilage lesion score did not show any significant difference between groups. Malacia was not observed in any tracheal segment. Overall, the glycerin-preserved tracheal implant had low antigenicity and good rigidity, but showed incomplete revascularization.
