Benign Tracheobronchial Stenoses: Long-term Clinical Experience with Balloon Dilation

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PURPOSE

To assess the safety and long-term efficacy of balloon dilation in the treatment of benign tracheobronchial stenosis.

MATERIALS AND METHODS

Balloon dilation was performed under fluoroscopic guidance in 59 consecutive patients with benign tracheobronchial stenosis. Most patients had tuberculosis (48 of 59, 81%). Two to three serial balloon insufflations were performed for 5–180 seconds (mean, 85 sec) with inflation pressures as high as 16 atm with use of 6–20-mm-diameter balloon catheters. Patients with clinical evidence of restenosis underwent repeat balloon dilation. Patients were followed for 12–42 months (mean, 32 mo).

RESULTS

A total of 101 balloon dilation sessions were performed in 59 patients, with a range of one to four sessions per patient (mean, 1.7 sessions). Initial symptomatic improvement was achieved in 49 (83%) of the 59 patients; however, during the follow-up period, 39 (80%) of the 49 patients experienced recurrence of their symptoms. The primary patency rates at 3, 6, 9, 12, 18, 24, and 32 months were 92%, 60%, 45%, 24%, 20%, 20%, and 20%, respectively. The secondary patency rates at 3, 6, 9, 12, 18, 24, and 32 months were 92%, 87%, 75%, 43%, 43%, 43%, and 43%, respectively. Procedure-related major complications of deep mucosal laceration (n = 2) and bronchospasm (n = 1) occurred in three patients, but they experienced no subsequent problems.

CONCLUSION

Although the recurrence rate is high during the long-term follow-up period, balloon dilation seems to be a safe primary treatment modality for benign tracheobronchial stenoses and has an acceptable secondary patency rate.

Section snippets

Patients

From November 1994 to September 2000, 59 consecutive patients (45 women and 14 men; age range, 1–76 y; mean age, 36 y) were treated by means of fluoroscopically guided balloon dilation. These patients were followed for at least 12 months and the results were evaluated retrospectively. Indications for balloon dilation included clinical respiratory symptoms (eg, dyspnea, cough, stridor, wheeze, or recurrent postobstructive pneumonia), decline of pulmonary function test (PFT) results, and stenosis

Initial Improvement

A total of 101 balloon dilation sessions were performed in 59 patients, with a range of one to four sessions per patient (mean, 1.7 sessions). Balloon dilation was performed in a single session in 35 patients, two sessions in 10 patients, three sessions in 10 patients, and four sessions in four patients. There were no technical failures. Clinical success was achieved in 49 (83%) of the 59 patients (Fig 1). These patients described a subjective improvement of physical well-being and ease of

DISCUSSION

Since the first report of balloon dilation to treat tracheobronchial stenosis by Cohen et al (3) in 1984, several reports have described the usefulness of balloon dilation in the treatment of airway stenosis. Short-term results of balloon dilation to treat benign tracheobronchial stenosis have been favorable (9, 10, 11). However, the longterm efficacy of balloon dilation in a large number of patients has rarely been reported. Carre et al (11) reported a 100% clinical success rate and 50%

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    None of the authors has identified a conflict of interest.

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