Large airway obstruction occurs secondary to a variety
|
|
- Justin Cross
- 6 years ago
- Views:
Transcription
1 Medium-Term Follow-Up After Deployment of Ultraflex Expandable Metallic Stents to Manage Endobronchial Pathology Brendan P. Madden, MD, FRCP, John E. S. Park, MA, MRCP, and Abhijat Sheth, FRCS Department of Cardiothoracic Surgery, St. George s Hospital, London, England Background. Between March 1997 and March 2004 we deployed 80 Ultraflex metallic expandable stents (Boston Scientific, Waterson, MA) in 69 patients under direct vision using rigid bronchoscopy. We report our mediumto long-term experience in patients for whom these stents were deployed. Methods. To date 15 patients have been followed for more than 1 year (median 41 months, range 12 to 83 months) after stent deployment. Indications for stenting in these patients were neoplasia (5), stricture (5), airway malacia (1), iatrogenic tracheal tear (1), and compression from an aortic aneurysm (1), a right interrupted aortic arch (1), and a right brachiocephalic artery aneurysm with tracheomalacia (1). Ten tracheal stents (9 covered, 1 uncovered) and 10 bronchial stents (8 uncovered, 2 covered) were inserted, and 5 patients received two stents. Results. Five of these patients experienced no longterm problems. Complications included troublesome halitosis (5), which was difficult to treat despite various antibiotic regimes; granulation tissue formation above and below the stent that was successfully treated with low-power Nd:YAG laser therapy (7); and metal fatigue (1). We did not encounter stent migration. Conclusions. We conclude that Ultraflex expandable metallic stents have an important role in the management of selected patients with diverse endobronchial pathologies and are well tolerated in the long-term. Although associated granulation tissue can be successfully treated with Nd:YAG laser, halitosis can be a difficult problem to address. (Ann Thorac Surg 2004;78: ) 2004 by The Society of Thoracic Surgeons Large airway obstruction occurs secondary to a variety of disease processes ranging from benign disorders to rapidly advancing malignant disease. Respiratory distress often ensues and requires urgent investigation and treatment. Surgical intervention is the mainstay of treatment, but many patients may be unsuitable for such intercession because of advanced malignancy or medical comorbidity. Interventional bronchoscopy has proved to be a valuable alternative to operation for selected patients, allowing the placement of tracheobronchial stents to restore airway patency or seal defects. Stenting can also be used alongside other bronchoscopic therapies, including laser ablation, and can be beneficial in stabilizing patients before receiving further treatment such as radiotherapy and chemotherapy, or for improving airway dynamics and facilitating weaning from mechanical ventilatory support. As experience with endobronchial stenting and availability of the procedure increases concerns have been expressed regarding the complications that might be experienced by longer-term survivors. We have deployed 80 expandable metallic stents in 69 patients. We wished to assess the long-term impact of these stents in Accepted for publication May 20, Address reprint requests to Dr Madden, Department of Cardiothoracic Surgery, St. George s Hospital, London SW17 0QT, UK; brendan. madden@stgeorges.nhs.uk. our patients. From this population we report our experience of 15 patients who have now been followed up for more than 1 year after stent insertion. With increasing availability of this technique we believe it important to raise awareness of long-term tolerability and complications after metallic stent deployment. Material and Methods Covered and uncovered Ultraflex stents (Boston Scientific, Waterson, MA) were deployed. These consist of a flexible catheter delivery system with a compressed expandable metallic stent held in place by a crocheted nylon suture wrapped around it. The stent is composed of an open-ended cylindrical titanium mesh constructed from a single-stranded nitinol wire (SMA, Inc, San Jose, CA); the delivery catheter from which the stent is deployed has a flush taper tip at the distal end and a round hub handle at the proximal end. Covered stents have a single layer of translucent polyvinyl chloride enveloping the midsection of the metallic mesh. The crocheted release mechanism allows controlled stent deployment. The stents provide constant radial pressure maintaining patency while minimizing traumatic tissue compression and adapt to anatomic contours, thus enhancing patient comfort. Before stent placement all patients had rigid and flexible bronchoscopy under general anesthesia. The 2004 by The Society of Thoracic Surgeons /04/$30.00 Published by Elsevier Inc doi: /j.athoracsur
2 Ann Thorac Surg MADDEN ET AL 2004;78: MEDIUM-TERM METALLIC STENT FOLLOW-UP relevant airway portion was sized at this time and a stent was selected to bridge the lesion and overlap the normal mucosa by at least 10 mm at each end. The diameter of the stent was chosen to match the diameter of the normal proximal lumen. Stent placement was performed under direct vision by passing the delivery device through the rigid bronchoscope and retracting the nylon crotched suture when satisfied with appropriate placement, followed by removal of the delivery device. Correct positioning and deployment of the stent was then confirmed by bronchoscopy at the time of the procedure and by chest radiograph subsequently. Bronchoscopy was performed to check stent positioning at 14 days after deployment and subsequently as dictated by clinical indication. Details of the patients stented, the stents used, the indication for stenting, and the site of stenting were recorded at the time of discharge after stent placement. These data were analyzed retrospectively to determine patients who had stents placed for more than 1 year. Data concerning the status of these patients, complications, and follow-up period were retrieved from the hospital computerized patient information and results systems, medical notes, and clinic letters. In 1 patient the type and site of stent were recorded, but the indication for stenting had not been noted and the medical notes were unavailable. The computerized hospital results system did not aid in determining the diagnosis, but did list the patient as being deceased less than 12 months after stent deployment. Results Between March 1997 and February 2004 we deployed 80 stents in 69 patients (36 women, 33 men, median age 63 years, range 19 to 84 years). Thirty bronchial and 50 tracheal stents were sited. Indications for stenting are summarized in Table 1. We identified 15 patients who were followed up for more than 1 year after stent deployment (Table 2). Fourteen are still alive, but 1 died from a myocardial infarction 15 months after having a tracheal stent placed to relieve airway obstruction secondary to tracheomalacia and external compression from a right brachiocephalic artery aneurysm. Five of these patients experienced no long-term complications after stent deployment. Complications that occurred are summarized in Table 3. Granulation tissue formation was the most common, occurring in 7 patients. This complication was related to the uncovered tips of the stents in each patient, occurring proximally in 2 patients, distally in 4 patients, and at the upper and lower ends of the stent in 1 patient. In one case, one of our first stented patients, the patient declined to be followed up by us because of travel distance. He was subsequently re-referred with dyspnea due to extensive granulation tissue formation around the distal end of the stent. Complete clearance with Nd:YAG laser therapy was not possible. Granulation tissue developed in patient 4 but did not require treatment because it did not cause significant obstruction and had not progressed at serial bronchoscopy. The remaining 5 patients Table 1. Indications and Numbers of Patients for All Stents Inserted Diagnostic Category Specific Diagnosis No. of Patients Malignancy Primary lung carcinoma 22 Lung metastases or direct 14 invasion by nonlung primary Lymphomas 5 Myeloma 1 Malignant thymoma 1 Neuroendocrine tumor 1 Subtotal 44 Benign conditions Granulation tissue a 6 Tracheomalacia 5 Iatrogenic tracheal tear 2 Trachemalacia and 1 granulation tissue Bronchial stricture b 1 Benign multinodular goiter c 1 Tracheostomy subglottic web 1 Right brachiocephalic artery 1 aneurysm and tracheomalacia Inoperable aortic aneurysm 1 Right interrupted aortic arch 1 Bronchopleural pistula 1 Subtotal 21 Post lung transplant Anastomotic stricture 3 Unknown 1 TOTAL a Granulation tissue complicated prolonged intubation and mechanical ventilatory support (with tracheostomy) in 6 patients; b Following previously treated pulmonary tuberculosis; c This patient had congestive heart failure and end-stage chronic obstructive lung disease and was not considered suitable for thyroidectomy. were treated with low-power Nd:YAG laser. Of these, 1 (patient 7) required only one laser treatment and a second (patient 10) required two treatments. Both had subsequent bronchoscopies showing no further growth. One (patient 1) received one laser treatment and subsequent dilatations of the region with bougie dilators. The remaining 2 patients (patients 3 and 11) required three courses of laser therapy. Patient 3 required the three courses during the first 18 months after stent deployment and has not required any further treatment since that time. Patient 11 also required three courses of Nd:YAG laser treatment to date and continues to be followed up with regular bronchoscopic surveillance. Although we appreciate the potential risk of airway injury as a consequence of combustion to the stent with laser therapy applied locally, this complication did not occur in our series. We used low power (10 W) with a contact fiber and interrupted mechanical ventilatory support during treatment. All of the patients remain asymptomatic from an airway standpoint and had good airway patency. Halitosis is a troublesome complication, and was seen in 5 patients. Seven stents were placed in these 5 patients. GENERAL THORACIC
3 Table 2. Patients Followed-Up for More Than 12 Months After Endobronchial Stent Deployment Patient No. Age (years) Sex No. of Stents Site of Stents Type of Stents Diagnosis Reason for Stent Complications 1 44 F 1 B UNC Bilateral lung transplant Anastomotic stricture GT M 1 B COV TB Fibrotic stricture Halitosis, GT F 1 T COV Tracheostomy Stricture GT 42 Tracheal web repair 4 36 F 1 B UNC Single lung transplant Anastomotic stricture GT F 1 B UNC Single lung transplant Anastomotic stricture None M 2 B & T UNC & COV Adenocystic Ca Intrinsic compression None F 2 B & T UNC & COV Adenocystic Ca Intrinsic compression GT, metal fatigue F 1 T COV Rt brachiocephalic artery aneurysm Extrinsic compression Halitosis F 2 T COV Post Op CABG & AVR Tracheomalacia Halitosis F 1 T COV Rt aortic arch Extrinsic compression GT M 1 T COV ITU ventilated Tracheal tear Halitosis, GT F 2 B & T UNC & COV NHL Extrinsic compression Halitosis F 2 B & T UNC Malignant thymoma Extrinsic compression None F 1 B UNC Left upper lobectomy (for Ca lung) Extrinsic compression None F 1 B COV Aortic aneurysm Extrinsic compression None 15 Follow-Up (months) AVR aortic valve replacement; B bronchial; Ca carcinoma; CABG coronary artery bypass grafting; COV covered; F female; GT granulation tissue; ITU intensive therapy unit; M male; NHL non-hodgkin s lymphoma; Op operation; Rt right; T tracheal; TB tuberculosis; UNC uncovered MADDEN ET AL Ann Thorac Surg MEDIUM-TERM METALLIC STENT FOLLOW-UP 2004;78:
4 Ann Thorac Surg MADDEN ET AL 2004;78: MEDIUM-TERM METALLIC STENT FOLLOW-UP Table 3. Number of Complications After Stent Deployment Complication All had covered stents (1 bronchial, 5 tracheal), with one having both covered (tracheal) and uncovered (bronchial) stents in place. Attempts were made to determine the cause of the halitosis. Barium swallow investigations in all did not show gastroesophageal reflux; highresolution computed tomography scanning did not reveal bronchiectasis. In addition all had microbiological samples (bronchoalveolar lavage) taken at subsequent bronchoscopies and sputum samples collected. Samples from 3 of the 5 patients did not grow any bacteria other than normal upper respiratory tract flora. The remaining 2 grew Pseudomonas aeruginosa. Treatment courses with intravenous and oral antibiotics, to which the species had proven sensitivity, were unsuccessful in eradicating the halitosis; nebulized antibiotic regimes were similarly unhelpful. Unfortunately halitosis continues to be a problem in these patients. Some patients receiving endobronchial stenting have episodes of recurrent respiratory tract infection (RTI) early after stent deployment. Recurrent RTI was not, however, a problem for any of the 15 patients 1 year after stent deployment. Bronchoscopy revealed evidence of epithelialization around uncovered ends of covered stents and through uncovered stents. Reassuringly we did not encounter stent migration. In one patient a stent did exhibit metal fatigue in which one of the metal struts was fragmented, but this condition did not cause any damage or compromise to the airway and has to date not required further intervention. One patient (patient 12) gave birth to a healthy child 16 months after stent deployment. Comment No. of Patients Granulation tissue 7 Halitosis 5 Metal fatigue 1 Interventional bronchoscopy techniques have developed progressively over the last decade. Large airway obstruction often presents as a medical emergency that requires prompt action to prevent suffocation. Surgical resection and reconstruction is the gold standard definitive treatment, but many patients are unsuitable for surgical intervention. It is for these patients that interventional bronchoscopy potentially has a useful role. For the majority with inoperable malignancy as a cause of airway obstruction, palliation is the aim of stent placement. The management of such situations with bronchoscopic strategies, including laser therapy and stenting, have been shown to be of benefit not only for symptomatic relief but also for physiologic respiratory measurements [1 6]. Furthermore an increase in availability of interventional bronchoscopy and improvements in technology and techniques has resulted in an increase in the number of 1901 individuals (particularly those who are poor surgical candidates) receiving intervention for airways obstruction as a result of more benign conditions. Concerns have, however, been raised regarding the complications in long-term survivors with expandable metal airway stents [7]. In our series granulation tissue formation was the most common complication, mirroring the experiences of other groups [8]. We have shown that this problem can be treated easily and effectively with Ng-YAG laser therapy. In addition we have found that granulation tissue may not require continued laser treatments, but instead only a discrete number of laser treatments in some patients. Such patients should continue to be followed up to monitor for recurrence. Halitosis proves to be a distressing and difficult complication to resolve. Previous studies have suggested that this condition is secondary to bacterial infection of the stent. All of our patients with halitosis had covered stents, which may provide a suitable environment for bacterial growth and prevent effective mucociliary clearance. Noppen and colleagues [9] showed that 78% of those receiving mainly silicone stents developed significant airways colonization with bacteria, of which 55% had potentially pathogenic organisms. Their study also found that the most common organisms found were P aeruginosa, the only potentially pathogenic organism we found to be present in our patients with halitosis. The polysaccharide glycocalyx material surrounding the outer cell wall of this organism may enhance its ability to bind to the polyvinyl chloride coating of covered stents and possibly explain our difficulty in eradicating the problem. Not only was antibiotic treatment guided by culture sensitivity ineffective, but so were empirical antibiotic regimes in patients with negative cultures. Similarly, nebulized antibiotics had no benefit in these patients. In light of the primary airway pathology and difficulty in removing the stents once deployed we did not believe that stent removal was an appropriate strategy. Only 40% of our patients with halitosis had positive microbiology from either sputum samples or bronchoalveolar lavage; therefore, bacterial growth does not appear to be the sole cause of halitosis, although this hypothesis is attractive. Halitosis can occur with prosthetic replacement of the trachea and it may be less of a problem for patients with removable stents deployed. However, these latter stents also have associated complications and furthermore it was our clinical assessment that metallic stents were appropriate for our patients. It is hoped that further research into this problem, including the structure of the covered stents themselves, will help resolve what can be a distressing issue for patients. Stent migration did not prove a problem in our series. We believe that this is due to accurate sizing of both airway diameter and distance to be stented at the time of stent insertion. Furthermore, the ability to directly visualize stent deployment under rigid bronchoscopy and make minor adjustments as required immediately after deployment provided additional accuracy [10, 11]. We GENERAL THORACIC
5 1902 MADDEN ET AL Ann Thorac Surg MEDIUM-TERM METALLIC STENT FOLLOW-UP 2004;78: have not had any indication to remove the stents once they have been deployed. Metal fatigue was seen in only 1 of our patients, and this did not require any further intervention. Metal fatigue does present a potentially important complication and one that should continue to be monitored with patients having stents deployed who survive for longer periods. A previous long-term follow-up study [8] also reported metal fatigue in one stent (0.89%) at 48 months after stent deployment. No clinical sequelae were reported and the stent was successfully removed. We used covered stents to manage the airway in 3 patients who had extrinsic vascular compression of the airway. None of these patients was considered a candidate for formal vascular surgical intervention. Given the structure of the stents and the nature of the radial forces exerted by them on the airway, we did not believe that they would contribute to vascular erosion. These patients have been followed to date for 14, 15, and 39 months after stent deployment. All of our patients gained considerable benefit in terms of clinical and respiratory status after stent insertion. Five patients had no complications in the medium-term associated with their stent, and 1 subsequently gave birth to a healthy child 16 months after stent deployment. Our experience suggests that Ultraflex expandable metallic stents have a role to play in the management of a variety of endobronchial pathologies for carefully selected patients. Long-term complications do not necessitate stent removal and, with the exception of halitosis, can usually be managed effectively. References 1. Wood D, Liu Y, Vallieres E, Karmy-Jones R, Mulligan M. Airway stenting for malignant and benign tracheobronchial stenosis. Ann Thorac Surg 2003;76: Chan K, Eng P, Hsu A, Huat G, Chow M. Rigid bronchoscopy and stenting for esophageal cancer causing airway obstruction. Chest 2002;122: Wilson G, Walshaw M, Hind C. Treatment of large airway obstruction in lung cancer using expandable metal stents under direct vision via the fiberoptic bronchoscope. Thorax 1996;51: Monnier P, Mudry A, Stanzel F, et al. The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers. A prospective, multicenter study. Chest 1996;110: Miyazawa T, Yamakido M, Ikeda S, et al. Implantation of Ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest 2000;118: Vonk-Noordegraaf A, Postmus P, Sutedja T. Tracheobronchial stenting in the terminal care of cancer airways obstruction. Chest 2001;120: Saad CP, Murthy S, Krizmanich G, Mehta AC. Selfexpandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis. Chest 2003;124: Gaissert H, Grillo H, Wright C, Donahue D, Wain J, Mathisen D. Complication of benign tracheobronchial strictures by self-expanding metal stents. J Thorac Cardiovasc Surg 2003;126: Noppen M, Pierard D, Meysman M, Claes I, Vincken W. Bacterial colonization of central airways after stenting. Am J Respir Crit Care Med 1999;160: Madden BP, Datta S, Charokopos N. Experience with Ultraflex expandable metallic stents in the management of endobronchial pathology. Ann Thorac Surg 2002;73: Madden BP, Stamenkovics A, Mitchell P. Covered expandable tracheal stents in the management of benign tracheal granulation tissue formation. Ann Thorac Surg 2000;70:
Tracheobronchial stents are useful in the management
Do Expandable Metallic Airway Stents Have a Role in the Management of Patients With Benign Tracheobronchial Disease? Brendan P. Madden, MD, FRCP, Tuck-Kay Loke, MRCP, and Abhijat C. Sheth, FRCS Department
More informationTherapeutic Bronchoscopy Etiology - Benign Stenosis Post - intubation Trauma Post - operative Inflammatory Idiopathic
Endobronchial Palliation of Airway Disease Douglas E. Wood, MD Professor and Chief Division of Cardiothoracic Surgery Vice-Chair, Department of Surgery Endowed Chair in Lung Cancer Research University
More informationThe use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction
The use of metallic expandable tracheal stents in the management of inoperable malignant tracheal obstruction Alaa Gaafar-MD, Ahmed Youssef-MD, Mohamed Elhadidi-MD A l e x a n d r i a F a c u l t y o f
More informationFactors leading to tracheobronchial self-expandable metallic stent fracture
GENERAL THORACIC SURGERY Factors leading to tracheobronchial self-expandable metallic stent fracture Fu-Tsai Chung, MD,* Shu-Min Lin, MD,* Hao-Cheng Chen, MD, Chun-Liang Chou, MD, Chih-Teng Yu, MD, Chien-
More informationRigid Bronchoscopic Intervention in Patients with Respiratory Failure Caused by Malignant Central Airway Obstruction
ORIGINAL ARTICLE Rigid Bronchoscopic Intervention in Patients with Respiratory Failure Caused by Malignant Central Airway Obstruction Kyeongman Jeon, MD, Hojoong Kim, MD, Chang-Min Yu, MD, Won-Jung Koh,
More informationTherapeutic bronchoscopy for malignant airway stenoses: Choice of modality and survival
Original Article Free full text available from www.cancerjournal.net Therapeutic bronchoscopy for malignant airway stenoses: Choice of modality and survival ABSTRACT Background: There are no data regarding
More informationTemporary placement of metallic stent could lead to long-term benefits for benign tracheobronchial stenosis
Original Article on Airway Obstruction Temporary placement of metallic stent could lead to long-term benefits for benign tracheobronchial stenosis Guo-Wu Zhou*, Hai-Dong Huang*, Qin-Ying Sun*, Ye Xiong*,
More informationMetallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure
Eur Respir J 2008; 31: 1019 1023 DOI: 10.1183/09031936.00099507 CopyrightßERS Journals Ltd 2008 Metallic stent and flexible bronchoscopy without fluoroscopy for acute respiratory failure S-M. Lin*,#, T-Y.
More informationColonic Metal Stents MAKING A DIFFERENCE TO HEALTH
Colonic Metal Stents In a fast paced and maturing market, Diagmed Healthcare s Hanarostent has managed to continue to innovate and add unique and clinically superior features to its already premium range.
More informationRespiratory distress in patients with central airway obstruction
Indian J Thorac Cardiovasc Surg (2010) 26:151 156 DOI 10.1007/s12055-010-0021-0 ORIGINAL ARTICLE Respiratory distress in patients with central airway obstruction Mohamed Abdel Hamied Regal & Yasser Ahmed
More informationSuccessful Endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm
Successful Endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm Authors: David Comer (1), Amit Bedi (2), Peter Kennedy (2), Kieran McManus (2), and Werner McIlwaine
More informationDepartment of Thoracic Medicine, Chang Gung Memorial Hospital, Lin-Kuo Branch, Chang Gung Medical Foundation; Abstract
DOI 10.6314/JIMT.2017.28(4).07 2017 28 243-251 Impacts of Airway Self-expandable Metallic Stent on Ventilator Weaning and Survival of Mechanically Ventilated Patients with Esophageal Cancer and Cental
More informationDUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA
Solunum 3, Özel Sayı 2: 260-264, 2001 DUMON-NOVATECH Y-STENTS: A FOUR-YEAR EXPERIENCE WITH 50 TRACHEOBRONCHIAL TUMORS INVOLVING THE CARINA Jean F DUMON* M C DUMON* SUMMARY This article reports a 4-year
More information4/24/2017. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis. Tracheal Stenosis Endoscopic & Surgical Management
Endoscopic & Surgical Management Pressure ulceration Healing: granulation cicatrization contraction Ann Surg 1969;169:334-348 Gary Schwartz, MD Department of Thoracic Surgery and Lung Transplantation Baylor
More informationStenting for Esophageal Cancer Technical Issues and Outcomes
Stenting for Esophageal Cancer Technical Issues and Outcomes Moishe Liberman Director C.E.T.O.C. Division of Thoracic Surgery Centre Hospitalier de l Université de Montréal Disclosures Research and Educational
More informationMetallic Stent Placement for the Management of Tracheal Carina Strictures and Fistulas: Technical and Clinical Outcomes
Vascular and Interventional Radiology Original Research Kim et al. Outcomes of Tracheal Stent Placement Vascular and Interventional Radiology Original Research Jinoo Kim 1 Ji Hoon Shin 2 Jin-Hyoung Kim
More informationMetallic Stent and Flexible Bronchoscopy without Fluoroscopy for
ERJ Express. Published on January 9, 2008 as doi: 10.1183/09031936.00099507 Metallic Stent and Flexible Bronchoscopy without Fluoroscopy for Acute Respiratory Failure Shu-Min Lin, MD*,Ting-Yu Lin, MD*,
More informationDouble Y-stenting for tracheobronchial stenosis
ERJ Express. Published on April 10, 2012 as doi: 10.1183/09031936.00015012 Double Y-stenting for tracheobronchial stenosis M. Oki and H. Saka AFFILIATIONS Dept of Respiratory Medicine, Nagoya Medical Center,
More informationAirway stenting in excessive central airway collapse
Review Article on Aerodigestive Endoscopy Airway stenting in excessive central airway collapse Mihir Parikh, Jennifer Wilson, Adnan Majid, Sidhu Contributions: (I) Conception and design: All authors; (II)
More informationBiliary Metal Stents MAKING A DIFFERENCE TO HEALTH
Biliary Metal Stents In a fast paced and maturing market, Diagmed Healthcare s Hanarostent has managed to continue to innovate and add unique and clinically superior features to its already premium range.
More informationAdvanced Bronchoscopy
Advanced Bronchoscopy Radial Jaw 4 Pulmonary Forceps Ultraflex Tracheobronchial Stent System CRE Pulmonary Balloon Alair Bronchial Thermoplasty Catheter CRE Pulmonary Balloon Radial Jaw 4 Pulmonary Forceps
More informationSince central airway stenosis is often a lifethreatening. Double Y-stenting for tracheobronchial stenosis. Masahide Oki and Hideo Saka
Eur Respir J 2012; 40: 1483 1488 DOI: 10.1183/09031936.00015012 CopyrightßERS 2012 Double Y-stenting for tracheobronchial stenosis Masahide Oki and Hideo Saka ABSTRACT: The purpose of the present study
More informationСтенты «Ella-cs» Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts»
Уважаемые коллеги! Высылаем очередной выпуск «Issue of ELLA Abstracts» A. Esophageal Stenting and related topics 1 AMJG 2009; 104:1329 1330 Letters to Editor Early Tracheal Stenosis Post Esophageal Stent
More informationGastric / EUS Metal Stents
Gastric / EUS Metal Stents In a fast paced and maturing market, Diagmed Healthcare s Hanarostent has managed to continue to innovate and add unique and clinically superior features to its already premium
More informationNovatech Products for Interventional Pulmonology
Novatech Products for Novatech and Boston Medical Products Bringing you the finest products for Novatech is a manufacturer of top-quality medical products used successfully worldwide in the growing specialty
More informationThe Surgical Treatment of Tracheobronchial Tuberculosis. The Thoracic Department of Beijing Chest Hospital, Capital Medical University
The Surgical Treatment of Tracheobronchial Tuberculosis ) The Thoracic Department of Beijing Chest Hospital, Capital Medical University Named also: endobronchial tuberculosis,ebtb defined as tuberculous
More informationInterventional Pulmonology
Interventional Pulmonology The Division of Thoracic Surgery Department of Cardiothoracic Surgery New York Presbyterian/Weill Cornell Medical College p: 212-746-6275 f: 212-746-8223 https://weillcornell.org/eshostak
More informationUse of the Silicone T-tube to Treat Tracheal Stenosis or Tracheal Injury
Use of the Silicone T-tube to Treat Stenosis or Injury Chang-Jer Huang MD Backgound: stenosis or tracheal is a troublesome disease. Traditional temporary tracheostomy and reconstruction can resolve some
More informationMontgomery T-tube placement in the treatment of benign tracheal lesions
European Journal of Cardio-thoracic Surgery 36 (2009) 352 356 www.elsevier.com/locate/ejcts Montgomery T-tube placement in the treatment of benign tracheal lesions Angelo Carretta *, Monica Casiraghi,
More informationStents for airway strictures: selection and results
Review Article Stents for airway strictures: selection and results Adil Ayub, Adnan M. Al-Ayoubi, Faiz Y. Bhora Department of Thoracic Surgery, Icahn School of Medicine, Mount Sinai Health System, New
More informationIntroduction to Interventional Pulmonology
Introduction to Interventional Pulmonology Alexander Chen, M.D. Director, Interventional Pulmonology Assistant Professor of Medicine and Surgery Divisions of Pulmonary and Critical Care Medicine and Cardiothoracic
More informationAirway Remodeling: Preliminary Experience with Bio-Absorbable Airway Stents in Adults Jaus MO, Gonfiotti A, Barale D, Macchiarini P
Airway Remodeling: Preliminary Experience with Bio-Absorbable Airway Stents in Adults Jaus MO, Gonfiotti A, Barale D, Macchiarini P University Hospital Careggi Florence, Italy Disclosure Statement THE
More informationZenith Renu AAA Converter Graft. Device Description Planning and Sizing Deployment Sequence Patient Follow-Up
Zenith Renu AAA Converter Graft Device Description Planning and Sizing Deployment Sequence Patient Follow-Up Device description: Device indications The Zenith Renu AAA Converter Graft with Z-Trak Introduction
More informationMarc Noppen, MD, PhD, FCCP; Grigoris Stratakos, MD; Jan D Haese, MD; Marc Meysman, MD, FCCP; and Walter Vinken, MD, PhD
Removal of Covered Self-Expandable Metallic Airway Stents in Benign Disorders* Indications, Technique, and Outcomes Marc Noppen, MD, PhD, FCCP; Grigoris Stratakos, MD; Jan D Haese, MD; Marc Meysman, MD,
More informationIntravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)
Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Clare McLaren Great Ormond Street Hospital London Introduction IVUS and OCT supplementary techniques to angiography provide information
More informationOwen Dickinson. Consultant in Endoscopy & Interventional Radiology. Upper GI Stenting. Rotherham Foundation Trust
Owen Dickinson Consultant in Endoscopy & Interventional Radiology Upper GI Stenting Rotherham Foundation Trust Owen Dickinson Consultant in Endoscopy & Interventional Radiology Rotherham Foundation Trust
More informationAirway stent placement for malignant tracheobronchial strictures in patients with an endotracheal tube
Airway stent placement for malignant tracheobronchial strictures in patients with an endotracheal tube Poster No.: C-1121 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit M. J. Kim,
More informationDay 2 Pulmonary Breakout Interventional Pulmonology
Day 2 Pulmonary Breakout Interventional Pulmonology R. Paul Boesch, DO, MS Assistant Professor, Pulmonary Medicine Mayo Clinic Children s Center Interventional Pediatric Pulmonology or Pulm/ENT airway
More informationNeonatal Airway Disorders, Treatments, and Outcomes. Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center
Neonatal Airway Disorders, Treatments, and Outcomes Steven Goudy, MD Pediatric Otolaryngology Emory University Medical Center Disclosure I have nothing to disclose Neonatal and Pediatric Tracheostomy Tracheostomy
More informationENDOBRONCHIAL ABLATIVE THERAPIES. Christopher Cortes, MD, FPCCP
ENDOBRONCHIAL ABLATIVE THERAPIES Christopher Cortes, MD, FPCCP Choice of Ablative Therapy Size of the lesion Location of the lesion Characteristics of the lesion Availability of the different therapies
More informationEndobronchial Management of Benign, Malignant, and Lung Transplantation Airway Stenoses
Endobronchial Management of Benign, Malignant, and Lung Transplantation Airway Stenoses Joshua R. Sonett, MD, Robert J. Keenan, MD, Peter F. Ferson, MD, Bartley P. Griffith, MD, and Rodney J. Landreneau,
More informationSelf-expanding metallic stents (SEMS) have gained widespread
Bronchoscopic Extraction of Incorporated Self-Expanding Metallic Stents Sudish C. Murthy, MD, PhD, FACS, FCCP Self-expanding metallic stents (SEMS) have gained widespread acceptance as a treatment for
More informationISPUB.COM. Rare Cases: Tracheal/bronchial Obstruction. O Wenker, L Moehn, C Portera, G Walsh HISTORY ADMISSION
ISPUB.COM The Internet Journal of Radiology Volume 1 Number 1 O Wenker, L Moehn, C Portera, G Walsh Citation O Wenker, L Moehn, C Portera, G Walsh.. The Internet Journal of Radiology. 1999 Volume 1 Number
More informationAirway Simulation to Guide Stent Placement for Tracheobronchial Obstruction in Lung Cancer. Material and Methods
Airway Simulation to Guide Stent Placement for Tracheobronchial Obstruction in Lung Cancer Joseph B. Zwischenberger, MD, Gerhard R. Wittich, MD, Eric vansonnenberg, MD, Raleigh F. Johnson, PhD, Scott K.
More informationExternal trauma (MVA, surf board, assault, etc.) Internal trauma (Endotracheal intubation, tracheostomy) Other
Etiology External trauma (MVA, surf board, assault, etc.) Internal trauma (Endotracheal intubation, tracheostomy) Other Systemic diseases (vasculitis, etc.) Chemo/XRT Idiopathic Trans nasal Esophagoscope
More informationAudra Fuller MD, Mark Sigler MD, Shrinivas Kambali MD, Raed Alalawi MD
Clinical Series Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C Audra Fuller MD, Mark Sigler MD,
More informationSubject Index. Bacterial infection, see Suppurative lung disease, Tuberculosis
Subject Index Abscess, virtual 107 Adenoidal hypertrophy, features 123 Airway bleeding, technique 49, 50 Airway stenosis, see Stenosis, airway Anaesthesia biopsy 47 complications 27, 28 flexible 23 26
More informationTracheal Stricture and Fistula: Management With a Barbed Silicone-Covered Retrievable Expandable Nitinol Stent
Vascular and Interventional Radiology Original Research Kim et al. Tracheal Stent Vascular and Interventional Radiology Original Research Yong Hee Kim 1 Ji Hoon Shin 2 Ho-Young Song 2 Jin Hyoung Kim 2
More informationExpandable stents in digestive pathology present use in an emergency hospital
ORIGINAL ARTICLES Article received on November30, 2015 and accepted for publishing on December15, 2015. Expandable stents in digestive pathology present use in an emergency hospital Mădălina Ilie 1, Vasile
More informationThe first stents designed for use in the biliary tree and
Imaging and Advanced Technology Michael B. Wallace, Section Editor Expandable Gastrointestinal Stents TODD H. BARON Department of Medicine, Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester,
More informationSuccessful endoscopic dilatation to alleviate airway suffocation in a case with. esophageal cancer after stent implantation
Successful endoscopic dilatation to alleviate airway suffocation in a case with esophageal cancer after stent implantation by Masanori Yasuo MD, PhD*, Shino Furuya MD*, Shintaro Kanda MD*, Yoshimichi Komatsu*
More informationTracheal Stenosis Following Cuffed Tube Tracheostomy
Tracheal Stenosis Following Cuffed Tube Tracheostomy Anatomical Variation and Selected Treatment Armand A. Lefemine, M.D., Kenneth MacDonnell, M.D., and Hyung S. Moon, M.D. ABSTRACT Tracheal stenosis resulting
More informationMalignant tracheobronchial stenosis is a life-threatening. Management of Malignant Tracheobronchial Stenoses with the Use of Airway Stents
Original Article J Chin Med Assoc 2004;67:458-464 Jang-Ming Su 1 Tzu-Chin Wu 2 Ming-Fang Wu 3 Han Chang 4 Ming-Chih Chou 1,5 1 Division of Thoracic Surgery, Department of Surgery, 2 Division of Chest Medicine,
More informationAnaesthesia for surgery of the trachea and main bronchi
Anaesthesia for surgery of the trachea and main bronchi Alistair Macfie Christopher Hawthorne Abstract Major surgery on the trachea and airway is an anaesthetic challenge, which necessitates the simultaneous
More informationTRACHEOSTOMY. Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion
TRACHEOSTOMY Definition Tracheostomy means creation an artificial opening in the trachea with tracheostomy tube insertion Indications for tracheostomy 1-upper airway obstruction with stridor, air hunger,
More informationRevisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis
Jpn J Clin Oncol 1997;27(5)305 309 Revisit of Primary Malignant Neoplasms of the Trachea: Clinical Characteristics and Survival Analysis -, -, - - 1 Chest Department and 2 Section of Thoracic Surgery,
More informationBifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully
Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully supported by self-expanding z-stents H&L-B
More informationInternational Journal of Health Sciences and Research ISSN:
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Case Report Varied Presentation and Management of Tracheal Polyps in Children Vinod M Raj 1, Varun Hathiramani 2, Swathi
More informationTracheo-innominate artery fistula (TIF) is an uncommon
Technique for Managing Tracheo-Innominate Artery Fistula Gorav Ailawadi, MD Tracheo-innominate artery fistula (TIF) is an uncommon complication (0.1-1%) following both open and percutaneous tracheostomy.
More informationCase Report. Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* Abstract. Introduction.
121 Case Report Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report* André Germano Leite 1, Douglas Kussler 2 Abstract The authors report the case of a patient with
More informationCase Report Reoperation for complicated tracheoesophageal fistula after surgery of a tracheal lymphoma
Int J Clin Exp Med 2017;10(6):9659-9663 www.ijcem.com /ISSN:1940-5901/IJCEM0051182 Case Report Reoperation for complicated tracheoesophageal fistula after surgery of a tracheal lymphoma Wei Dai 1, Qiang
More informationTHE THE MORE MORE NATURAL APPROACH TO OPTIMAL FIT
THE THE MORE MORE NATURAL APPROACH Natural Approach TO Optimal Fit TO OPTIMAL FIT Conformability without Compromise THE STANDARD IN Conformability AND Designed for flexibility and conformability in tortuous
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationTracheal Trauma: Management and Treatment. Kosmas Iliadis, MD, PhD, FECTS
Tracheal Trauma: Management and Treatment Kosmas Iliadis, MD, PhD, FECTS Thoracic Surgeon Director of Thoracic Surgery Department Hygeia Hospital, Athens INTRODUCTION Heterogeneous group of injuries mechanism
More informationAcute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
More informationSurgical indications: Non-malignant pulmonary diseases. Punnarerk Thongcharoen
Surgical indications: Non-malignant pulmonary diseases Punnarerk Thongcharoen Non-malignant Malignant as a pathological term: Cancer Non-malignant = not cancer Malignant as an adjective: Disposed to cause
More informationSurgical Repair of Iatrogenic Cervical Tracheal Stenosis
Surgical Repair of Iatrogenic Cervical Tracheal Stenosis Nirmal K. Veeramachaneni, MD, and Bryan F. Meyers, MD, MPH he advent of intensive care unit management has increased the potential opportunities
More informationSubglottic stenosis, with involvement of the lower larynx
Laryngotracheal Resection and Reconstruction John D. Mitchell, MD n, Subglottic stenosis is being recognized with increasing frequency in adults, and may be the most frequent indication for airway intervention
More informationHistory of the Powerlink System Design and Clinical Results. Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ
History of the Powerlink System Design and Clinical Results Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ Powerlink System: Unibody-Bifurcated Design Long Main Body Low-Porosity Proprietary eptfe
More informationIs a Metallic Stent Useful for Non Resectable Esophageal Cancer?
Original Article Is a Metallic Stent Useful for Non Resectable Esophageal Cancer? Shinsuke Wada, MD, 1 Tsuyoshi Noguchi, MD, 1 Shinsuke Takeno, MD, 1 Hatsuo Moriyama, MD, 1 Tsuyoshi Hashimoto, MD, 1 Yuzo
More informationApproach to the Biliary Stricture
Approach to the Biliary Stricture ACG Eastern Postgraduate Course Washington DC June 8, 2014 Steven A. Edmundowicz MD FASGE Chief of Endoscopy Division of Gastroenterology Professor of Medicine Disclosures
More informationEndoscopy. Pulmonary Endoscopy
Pulmonary 1 Direct visualization of TB tree Developed in 1890 s to remove foreign bodies - rigid metal tube Advances added light system, Sx Flexible fiberoptic scopes introduced in early 1960 s 2 Used
More informationMRSA pneumonia mucus plug burden and the difficult airway
Case report Crit Care Shock (2016) 19:54-58 MRSA pneumonia mucus plug burden and the difficult airway Ann Tsung, Brian T. Wessman An 80-year-old female with a past medical history of chronic obstructive
More informationRecanalisation of urethral strictures with new-generation temporary covered biocompatible metal endoprostheses
Acta Chirurgica Iugoslavica (ACI) Vol: LIV, (3) 2007, pages 123-127 SCIENTIFIC PAPER UDC: 616.65-007.271-089.819.5 Recanalisation of urethral strictures with new-generation temporary covered biocompatible
More informationMalignant Tracheobronchial Strictures: Palliation with Covered Retrievable Expandable Nitinol Stent
Malignant Tracheobronchial Strictures: Palliation with Covered Retrievable Expandable Nitinol Stent Ji Hoon Shin, MD, Sang-We Kim, MD, Tae Sun Shim, MD, Gyoo-Sik Jung, MD, Tae-Hyung Kim, MS, Gi-Young Ko,
More informationOriginal article Bronchoscopic profile of various diseases in a rural care hospital
J M e d A l l i e d S c i 2 0 1 7 ; 7 ( 2 ) : 87-91 w w w. j m a s. i n P r i n t I S S N : 2 2 3 1 1 6 9 6 O n l i n e I S S N : 2 2 3 1 1 7 0 X Journal of M e d i cal & Allied Sciences Original article
More information2/3/2015. Anterior Mediastinal Masses and Lower Airway Problems
es and Lower Airway Problems es and Lower Airway Problems 25 y.o. Female Ant. Mediastinal Mass Cervical Mediastinoscopy + Biopsy Most Important History? A) Dysphagia B) Fever C) Orthopnea D) Chest pain
More informationEndoscopic Removal of Metallic Airway Stents*
bronchoscopy Endoscopic Removal of Metallic Airway Stents* William Lunn, MD, FCCP; David Feller-Kopman, MD, FCCP; Momen Wahidi, MD; Simon Ashiku, MD; Robert Thurer, MD, FCCP; and Armin Ernst, MD, FCCP
More informationAirway stenting 1. Douglas E. Wood, MD
Chest Surg Clin N Am 13 (2003) 211 229 Airway stenting 1 Douglas E. Wood, MD Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Washington, Box 356310, 1959 NE Pacific,
More informationAre metallic stents really safe? A long-term analysis in lung transplant recipients
Eur Respir J 2009; 34: 1417 1422 DOI: 10.1183/09031936.00041909 CopyrightßERS Journals Ltd 2009 Are metallic stents really safe? A long-term analysis in lung transplant recipients J. Gottlieb*, T. Fuehner*,
More informationCoated expandable metal stents are effective irrespective of airway pathology
Original Article Coated expandable metal stents are effective irrespective of airway pathology Cecilia Menna 1, Camilla Poggi 1, Mohsen Ibrahim 1, Antonio D Andrilli 1, Anna Maria Ciccone 1, Giulio Maurizi
More informationCovered stenting in patients with lifting of gastric and high esophago-tracheal fistula
European Radiology Springer-Verlag 2003 DOI 10.1007/s00330-002-1818-z Tips and Tricks in Radiology Covered stenting in patients with lifting of gastric and high esophago-tracheal fistula T. Lehnert J.
More informationMalignant related superior vena cava (SVC) syndrome
Malignant related superior vena cava (SVC) syndrome Manit Sae-teaw B.Pharm, BCP, BCOP Grad dip in Pharmacotherapy Faculty of pharmaceutical sciences Ubon Ratchathani University 1 Outline Introduction Etiology
More informationResults of Expandable Metal Stents for Malignant Esophageal Obstruction in 100 Patients: Short-Term and Long-Term Follow-up
Results of Expandable Metal Stents for Malignant Esophageal Obstruction in 100 Patients: Short-Term and Long-Term Follow-up Neil A. Christie, MD, Percival O. Buenaventura, MD, Hiran C. Fernando, MD, Ninh
More informationBalloon Bronchoplasty: Case Series
Original Article 2012 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran ISSN: 1735-0344 TANAFFOS Balloon Bronchoplasty: Case Series Hamid Reza Jabbardarjani 1, Arda Kiani 1, Negar
More informationZenith Alpha T HORACIC ENDOVASCULAR GRAFT
Device description Zenith Alpha T HORACIC ENDOVASCULAR GRAFT www.cookmedical.com AI-D21181-EN-F Modular design The two-piece modular system allows the physician to customize a graft system to fit each
More informationPulmonary. Pulmonary Endoscopy. Alair Bronchial Thermoplasty System. Transbronchial Aspiration Needles. Cytology Brushes.
Pulmonary Endoscopy Alair Bronchial Thermoplasty System Alair Bronchial Thermoplasty System... 79 Airway Stents Dynamic (Y) Stent... 79 Polyflex Self-Expanding Silicone Airway Stent... 82 Ultraflex Partially
More informationAERO DV Tracheobronchial Direct Visualization Stent System
AERO DV Tracheobronchial Direct Visualization Stent System Review Instructions For Use Before Using This System. Single Use Only Non-sterile MR Conditional CONTENTS Instructions for Use...............................
More informationTRACHEOBRONCHIAL FOREIGN BODY REMOVAL ADVICE IN DOGS AND CATS
Vet Times The website for the veterinary profession https://www.vettimes.co.uk TRACHEOBRONCHIAL FOREIGN BODY REMOVAL ADVICE IN DOGS AND CATS Author : MIKE STAFFORD-JOHNSON, MIKE MARTIN Categories : Vets
More informationEndobronchial valve insertion to reduce lung volume in emphysema
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Endobronchial valve insertion to reduce lung volume in emphysema Emphysema is a chronic lung disease that
More informationInterventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600
Endobronchial valve insertion to reduce lung volume in emphysema Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600 Your responsibility This guidance represents
More informationAncillary Components with Z-Trak Introduction System
Ancillary Components with Z-Trak Introduction System Zenith Flex AAA Endovascular Graft Ancillary Components Converter Converters can be used to convert a bifurcated graft into an aortouniiliac graft if
More informationEsophageal Perforation
Esophageal Perforation Dr. Carmine Simone Thoracic Surgeon, Division of General Surgery Head, Division of Critical Care May 15, 2006 Overview Case presentation Radiology Pre-operative management Operative
More informationArch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience
Arch Repair with the Bolton Medical RelayBranch Thoracic Stent-graft system: Multicenter experience Joost van Herwaarden, MD, PhD University Medical Center, Utrecht Disclosure I have the following potential
More informationAccess More Patients. Customize Each Seal.
Access More. Customize Each Seal. The Least Invasive Path Towards Proven Patency ULTRA LOW PROFILE TO EASE ADVANCEMENT The flexible, ultra-low 12F ID Ovation ix delivery system enables you to navigate
More informationLong-term follow-up of self-expandable metallic stents in benign tracheobronchial stenosis: a retrospective study
Xiong et al. BMC Pulmonary Medicine (2019) 19:33 https://doi.org/10.1186/s12890-019-0793-y RESEARCH ARTICLE Open Access Long-term follow-up of self-expandable metallic stents in benign tracheobronchial
More informationCase Report Tracheomalacia Treatment Using a Large-Diameter, Custom-Made Airway Stent in a Case with Mounier-Kuhn Syndrome
Case Reports in Pulmonology, Article ID 910135, 4 pages http://dx.doi.org/10.1155/2014/910135 Case Report Tracheomalacia Treatment Using a Large-Diameter, Custom-Made Airway Stent in a Case with Mounier-Kuhn
More informationTracheal stenosis is a frequent complication of tracheostomy
Endotracheal Balloon Dilatation and Stent Implantation in Benign Stenoses Bernd Schmidt, MD, Heidi Olze, MD, Adrian C. Borges, MD, Matthias John, MD, Uta Liebers, MD, Oliver Kaschke, MD, Konrad Haake,
More informationClinical Study Fully Covered Metallic Stents for the Treatment of Benign Airway Stenosis
Canadian Respiratory Journal Volume 2016, Article ID 8085216, 7 pages http://dx.doi.org/10.1155/2016/8085216 Clinical Study Fully Covered Metallic Stents for the Treatment of Benign Airway Stenosis Caroline
More informationJay B. Brodsky, M.D. Professor Department of Anesthesia tel: (650) Stanford University School of Medicine fax: (650)
Jay B. Brodsky, M.D. Professor Department of Anesthesia tel: (650) 725-5869 Stanford University School of Medicine fax: (650) 725-8544 Stanford, CA, 94305, USA e-mail: jbrodsky@stanford.edu RELIABLE SEPARATION
More information