When uncovered, metallic stents maintain ventilation and some ability to evacuate secretions if placed over lobar orifices. All metallic stents are radiopaque, and exhibit varying degrees of dynamic expandability. The second generation Wallstent and Ultraflex stents are available in both covered, partially and uncovered varieties while the Aero stent is a nitinol stent fully covered in polyurethane. The first generation airway metallic stents (Gianturco, Strecker, and Palmaz) were uncovered, rigid, non-conforming, stainless steel stents associated with an increased incidence of airway and vascular erosion. Disadvantages of silicone stents include their tendency to migrate and induce granuloma formation, insufficient flexibility to conform to irregular airways, higher rate of mucostasis, lower inner to outer diameter ratio, and the need for rigid bronchoscopy for placement. The benefits of silicone stents over metallic stents include relative easy of removal and replacement, lower cost, and no tumor invagination. Several tracheobronchial silicone stents are commercially available including the Dumon, Polyflex, Noppen, and Hood stents. Silicone stents: Silicone, a synthetic substance made of silicone elastomers, is firm and stable at high temperatures. The following section will discuss airway stent insertion additional procedures are discussed elsewhere. The definition of interventional pulmonology, originally published in European Respiratory Society (ERS) and American Thoracic Society (ATS) guidelines is “the art and science of medicine as related to the performance of diagnostic and invasive therapeutic procedures that require additional training and expertise beyond that required in a standard pulmonary medicine training program.” Clinical entities encompassed in this discipline include complex airway management, benign and malignant central airway obstruction, and pleural disease.ĭiagnostic and therapeutic procedures in interventional pulmonology include rigid bronchoscopy, transbronchial needle aspiration, autofluorescence bronchoscopy, endobronchial ultrasound, transthoracic needle aspiration and biopsy, laser bronchoscopy, endobronchial electrosurgery, argon plasma coagulation, cryotherapy, airway stent insertion, balloon bronchoplasty and dilatation techniques, endobronchial radiation (brachytherapy), photodynamic therapy, percutaneous dilatational tracheotomy, transtracheal oxygen catheter insertion, medical thoracoscopy, and image-guided thoracic interventions. General description of procedure, equipment, technique Airway Stents:
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