title: Management of benign dynamic "A-shape" tracheal stenosis: a retrospective study of 60 patients.
abstract: BACKGROUND
  Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management.
  
  
  METHODS
  Sixty patients with DATS were included. Management decision was made during initial bronchoscopy. When suitable, patients were referred to thoracic surgery for tracheal resection. Posterior localized tracheomalacia was treated with laser photocoagulation of the posterior tracheal wall. Tracheal stents were placed if the stenosis persisted after laser treatment. The choice of stent (straight silicone, hour-glass shaped silicone, T-tube, or fully-covered self-expandable metallic stent) was based on operator's judgment. After 12 to 18 months, stents were removed. If the stenosis persisted after stent removal, surgery was reconsidered. If surgery was not possible, a stent was replaced. In case of satisfactory result, a stent was replaced only after recurrence. Stable patients after treatment were considered as success, requirement of long-term tracheostomy or T tube as failure, and long-term stent as partial success.
  
  
  RESULTS
  All patients developed DATS after tracheostomy. Thirty-three patients had posterior tracheomalacia. In 13 patients, mild stenosis required only endoscopic surveillance. Two patients were referred to thoracic surgery for tracheal resection surgery. Endoscopic management was the initial therapy in 45 patients (75%) and was considered successful in 23 patients (51%), partially successful in 10 (22%), and failed in 12 (27%). Five patients with successful outcomes required only laser therapy. Overall 70 stents were placed in 35 patients, with a migration rate of 31%.
  
  
  CONCLUSIONS
  The DATS management was successful in 63%. Stent migration was frequent. Posterior tracheomalacia was successfully treated in selected cases, avoiding stent placement.
authors.affiliation: Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Plojoux
authors.affiliation: Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Laroumagne
authors.affiliation: Department of Pulmonology, Centre Hospitalier de l'Université de Montréal (CHUM) Hôpital Notre-Dame, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vandemoortele
authors.affiliation: Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France.
authors.forename: Philippe J
authors.initials: PJ
authors.lastname: Astoul
authors.affiliation: Department of Thoracic Surgery, North University Hospital, Marseille, France.
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Thomas
authors.affiliation: Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France. Electronic address: hdutau@ap-hm.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dutau
mesh_terms: D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D014135:Tracheal Stenosis / Q000145:classification / Q000473:pathology* / Q000601:surgery*