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We appreciate the interest that Drs. Anile and Ventura have in the management of lung transplant patients with distal focal bronchial stenosis (Type 3 disease) and diffuse distal stenosis (Type 4 disease). This is a complex group of patients to manage, and their airway issues can be challenging .
As a high volume center for bronchial stent placement (for causes other than transplantation), we have been uniformly disappointed with the use of expandable metallic stents. Metallic stents in the airway are associated with fracture, overgrowth of granulation tissue, erosion through the tracheobronchial wall, and are quite expensive. Although the cost of a single metallic stent is low in comparison to the total expense of lung transplantation, cost precludes having a large inventory of these stents available. We currently have an inventory of over 100 silastic stents (Silastic stents from Hood Laboratories, Pembroke, MA and Bryon Corporation, Woburn, MA). This inventory allows us to find the right stent for almost any airway, and allows us to taylor each stent to the individual’s patient’s needs and replace/upsize them as needed.
We have several practical tips for stenting of Type 3 and Type 4 bronchial stenosis:
Our experience has been that bronchoscopic surveillance and sequential “up-size” stenting for distal long-segment stenoses is an effective way to permanently increase luminal diameter over a long length of airway.
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