Airway Stenting
Airway stenting is a medical procedure used to treat narrowed or blocked airways in the lungs. The purpose of airway stenting is to restore the patency of the airway, which may be obstructed by a tumor, or to seal off a fistula between the airway and the esophagus. This procedure is commonly used for patients with conditions like lung cancer, chronic obstructive pulmonary disease (COPD), and other diseases that cause airway obstruction or fistulas.
During the procedure, the length of the stent required is assessed and corroborated with CT and bronchoscopic findings. A stent of appropriate length and diameter is introduced over a guidewire via the working channel of the bronchoscope under fluoroscopic guidance and radio-opaque skin markings. After confirming the position of the stent, it is expanded appropriately so that it covers the fistula or the stenotic area, ensuring improved airflow and symptom relief.
Airway stenting is usually done when other treatments, such as medications or surgery, are not effective. It's important to monitor the stent for any complications, as it can affect the patient’s breathing if not properly maintained.
Why Might I Need Airway Stenting?
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Chronic Obstructive Pulmonary Disease (COPD): Airway stenting may be used to alleviate obstruction caused by chronic conditions that affect the airways, such as COPD.
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Lung Cancer: If a tumor causes narrowing or blockage of the airway, stenting can help restore airflow.
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Tracheo-esophageal Fistula: Stenting can seal off a fistula between the airway and esophagus, preventing complications.
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Post-surgical Recovery: After surgery for airway obstruction, stents may be used to support the healing process and keep the airways open.
Possible Risks of Airway Stenting
Every effort will be made to conduct the procedure in such a way as to minimize discomfort and risks. However, just as with other types of procedures, there are inherent potential risks.
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General Complications: The incidence of major complications associated with bronchoscopy is 0.8% - 1.3%. These include accumulation of air in the pleural space, hemorrhage, subcutaneous emphysema, postoperative fever, chest infection, cardiac arrhythmias, hypoxemia, vasovagal attack, myocardial infarction, pulmonary edema, bronchospasm, choking, perforation of the airway, and tracheo-esophageal fistula.
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Stent-Specific Complications: These include misplacement, obstruction, migration, and failure of the stent.
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Mortality Rate: The mortality rate associated with bronchoscopy is less than 0.01%.
How Do I Get Ready for Airway Stenting?
Preparation for airway stenting is relatively simple, but it’s important to follow these guidelines for a successful procedure:
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Avoid Eating or Drinking: Do not eat or drink for several hours before the procedure to ensure your airways are clear.
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Medications: Your doctor may ask you to stop certain medications before the procedure. Follow their advice carefully.
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Arrange for Transportation: Since sedation may be used during the procedure, it's important to have someone drive you home afterward.
What Happens During the Airway Stenting Procedure?
During the procedure, the doctor will use a bronchoscope to guide the stent into place. The steps include:
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Bronchoscopy: A bronchoscope, a flexible tube with a camera, is inserted through the mouth or nose to view the airway and identify the area needing a stent.
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Stent Placement: The stent is introduced over a guidewire via the bronchoscope under fluoroscopic guidance, positioned, and expanded to cover the fistula or stenotic area.
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Post-Procedure Monitoring: After the procedure, you’ll be monitored for any complications, such as infection or issues with the stent.
The procedure usually takes around 30-60 minutes, and most patients can go home the same day.
What Happens After the Airway Stenting Procedure?
After the procedure, your doctor will discuss the results and the next steps:
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Postoperative Oxygen Supplementation: May be required in some patients, particularly those with impaired lung function and those who have been sedated.
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Chest Radiograph: A chest radiograph is carried out post-procedure to monitor for complications.
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Observation for Symptoms: Patients who have had transbronchial biopsies should observe for pain chest, breathlessness, haemoptysis, surgical emphysema, or excessive cough, which can indicate pneumothorax after leaving the hospital, and they should contact hospital emergency.
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Post-Sedation Guidelines: Patients who have been sedated are advised not to drive, sign legally binding documents, or operate machinery for 24 hours after the procedure.
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Support for Recovery: It is preferable that day case patients who have been sedated should be accompanied home, and higher-risk patients, such as the elderly or those from whom transbronchial biopsy specimens have been taken, should have someone to stay with them at home overnight.