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Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener’s granulomatosis
  1. S A R Nouraei1,
  2. R Obholzer1,
  3. P W Ind2,
  4. A D Salama3,
  5. C D Pusey3,
  6. F Porter4,
  7. D J Howard1,
  8. G S Sandhu1
  1. 1
    Department of Ear Nose and Throat Surgery, Charing Cross Hospital, London, UK
  2. 2
    Department of Respiratory Medicine, Hammersmith Hospital, London, UK
  3. 3
    Department of Renal Medicine, Hammersmith Hospital, London, UK
  4. 4
    Department of Anaesthesia, Charing Cross Hospital, London, UK
  1. Dr Reza Nouraei, National Centre for Airway Reconstruction, Department of Ear Nose and Throat Surgery, Charing Cross Hospital, London W6 8RF, UK; RN{at}cantab.net

Abstract

Background: Upper airway compromise due to tracheobronchial stenosis commonly occurs in patients with Wegener’s granulomatosis (WG). There is at present no consensus on the optimal management of this life threatening condition.

Objective: To assess the results of laryngo-tracheo-bronchoscopy, intralesional steroid therapy, laser surgery and dilatation in managing obstructive tracheobronchial WG.

Methods: Records of 18 previously untreated stridulous patients with obstructive tracheobronchial WG, treated between 2004 and 2006, were prospectively recorded on an airway database and retrospectively reviewed. Information about patient and lesion characteristics and treatment details were recorded. Treatment progress was illustrated using a timeline plot, and intervention-free intervals were calculated with actuarial analysis.

Results: There were nine males and the average age at presentation was 40 (16) years (range 13–74). There were 13 patients with tracheal and five with tracheal and bronchial lesions. The average tracheal lesion height was 8 (3) mm, located 23 (9) mm below the glottis. There were 1, 10 and 7 Myer-Cotton grade I, II and III lesions, respectively. Mean intervention-free interval following minimally invasive treatment was 26 (2.8) months. Following endobronchial therapy, the median intervention-free interval was 22 months (p>0.8 vs tracheal lesions). No patient required a tracheostomy or endoluminal stenting.

Conclusions: Intralesional steroid therapy and conservative endoluminal surgery is an effective strategy for treating airway compromise due to active tracheal and bronchial WG, obviating the need for airway bypass or stenting. We recommend the combination of endotracheal dilatation, conservative laser surgery and steroid therapy as the standard of care for treating airway compromise due to obstructive tracheobronchial WG.

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Footnotes

  • Competing interests: SARN, DJH and GSS have received a research grant from Alveolus Inc, which is a manufacturer of removable pulmonary stents for work unrelated to this project. Although our paper argues against the use of any stents in Wegener’s, we have discussed a proviso that if stenting does need to be done as the only available life saving procedure, then a removable stent must be used (for reasons laid out in the manuscript). As such, we feel that in the spirit of full transparency, the grant we have received from Alveolus, although unrelated to the present study, needs to be declared.

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