title: Experience with removing Palmaz stents with a rigid bronchoscope.
abstract: BACKGROUND
  The Palmaz stent can relieve congenital malacia or stenosis of airway, but reports on the indications and results of stent removal are rare. The authors report their experience in removing Palmaz stents and discuss the indications for removal.
  
  
  METHODS
  Thirteen stents in 12 patients were removed by a rigid bronchoscope for various reasons. The indications were expected recovery (n = 5), severe granulations and expected recovery (n = 2), stent collapse (n = 2), and stent migration and/or fracture (n = 4).
  
  
  RESULTS
  The course after removal was smooth in 9 patients and complicated in 3. The indications for stent removal in these 3 complicated cases were all expected recovery. One of the 3 complicated cases needed emergent cardiopulmonary bypass and tracheostomy for a collapsed stent that occluded airway, 1 failed for intractable bleeding, and 1 failed for intense vagal reflex causing cardiac arrest. At 6 months of follow-up, satisfactory results were seen in all but one case that needed further procedures for an iatrogenic tracheoesophageal fistula.
  
  
  CONCLUSIONS
  Most Palmaz stents can be removed smoothly with a rigid bronchoscope; however, lethal complications can happen. The authors suggest that indications for stent removal should be intractable airway symptoms caused by the stent rather than expected recovery. Muscle relaxants should be avoided during anesthesia to maintain spontaneous breathing, and cardiopulmonary bypass should be on standby.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Hsin-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Chinsu
authors.initials: C
authors.lastname: Liu
authors.forename: Pin-Tarng
authors.initials: PT
authors.lastname: Chen
authors.forename: Wen-Jue
authors.initials: WJ
authors.lastname: Soong
authors.forename: Wen-Kuei
authors.initials: WK
authors.lastname: Chang
authors.forename: Taiwai
authors.initials: T
authors.lastname: Chin
authors.forename: Chou-Fu
authors.initials: CF
authors.lastname: Wei
mesh_terms: D020680:Bronchoscopes; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000295:instrumentation*; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007223:Infant; D015607:Stents; D014133:Tracheal Diseases / Q000601:surgery*