The role of airway stents in the management of pediatric tracheal, carinal, and bronchial disease.
OBJECTIVE
A variety of stents are available to aid in the management of complex tracheal, carinal and bronchial stenoses. We reviewed our multi-institutional experience with airway stents in children.


METHODS
Thirty-three children (age, 13 days-18 years) from four institutions have had a total of 40 stents placed to aid in the management of complex airway stenoses. Three stent types were utilized: 29 silastic stents, five expandable metal stents and six customized carinal stents (four patients had two stents and one patient had four stents). Thirty children had tracheal stents, six children had bronchial stents, and two infants had carinal stents (three children had stenting of more than one area and two had stenting of all three locations). Twenty-eight patients (age, 5 months-18 years; mean, 8.06 years; SEM, 1.13 years) had stents placed after a variety of airway reconstructive procedures. Four underwent stenting in a non-operative setting and one as preoperative stabilization.


RESULTS
Twenty-seven patients survived. One patient died early due to bleeding. Five patients died late: two due to bleeding, one from mediastinitis, and two patients with functional airways died late from unrelated problems. Complications are related to stent type and location. Carinal stents can migrate; several techniques are available to help manage this problem. Wire stents are essentially non-removable requiring periodic dilation. Silastic stents stimulate granulation tissue formation requiring periodic bronchoscopic removal.


CONCLUSIONS
Tracheal stenting can aid in the management of pediatric airway problems. Complications are common, but can be managed with appropriate intervention.
Jacobs
J P
JP
Division of Thoracic and Cardiovascular Surgery, All Children's Hospital/University of South Florida School of Medicine, St Petersburg, FL 33701, USA. jjacobs1@compuserve.com
Quintessenza
J A
JA
Botero
L M
LM
van Gelder
H M
HM
Giroud
J M
JM
Elliott
M J
MJ
Herberhold
C
C
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D001982:Bronchial Diseases / Q000150:complications*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D003251:Constriction, Pathologic / Q000150:complications; D004129:Dimethylpolysiloxanes; D004867:Equipment Design; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012828:Silicones; D015607:Stents / Q000009:adverse effects / Q000145:classification / Q000600:supply & distribution; D016019:Survival Analysis; D014135:Tracheal Stenosis / Q000150:complications*; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D004129:Dimethylpolysiloxanes; D012828:Silicones; C013830:baysilon