Abstract

Stenting of the lower conducting airways, i.e. prosthesizing of the trachea and large bronchi with tubular devices to maintain the integrity of hollow airways, has become widely used in treatment of endotracheo-bronchial disorders owing to major achievements in bronchoscopy and interventional pulmonology. Permanent obstructive tracheobronchial disorders can be caused by malignant or benign tumors, extrinsic compression, postintubational tracheal injuries, sequelae after tracheostomy, or tracheobronchomalacia. Specially designed airway stents are being increasingly used to palliate the effects of large airways obstructions.
There are four main types of stents currently in use: silicone stents, expandable metallic stents, covered metallic stents, and true hybrid stents made of both silicone and metal (e.g. dynamic tracheal stent or the Freitag stent). Stents of different types have different advantages and disadvantages.
Silicone stents are usually placed with the aid of a rigid bronchoscope, while the patient is under general anesthesia. Metallic stents can be placed with a flexible bronchoscope.
In Estonia, stenting of the large airways started in 1993 at the Lung Clinic of Tartu University Clinics. First, specially designed dynamic tracheal stents were placed and Tartu became the only centre for airway stenting in Estonia, serving patients with complicated airway stenosis from the whole country until 2003. Since 2003, stenting of the airways was started also in the Department of Thoracic Surgery of the Regional Hospital of Northern Estonia, where linear Polyflex stents were applied for the first time in Estonia. Hence, there are altogether two centres for airway stenting in Estonia at present. Since 2003, six dynamic tracheal stents and between 2003 and 2005, twelve Polyflex stents have been placed in Estonia. In all patients, positive results have been achieved in recovery of the airway lumen and this is supported also by dramatic improvement in their lung function parameters and quality of life.
In summary, large airway stenting represents major progress in the field of interventional pulmonology. Due to the objectively increasing need for this method of palliative treatment in Estonia, airway stenting should be used much more extensively and also in patients whose airway obstruction is caused by inoperable malignant diseases in order to increase their quality of life and survival.