With Applicator

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With Applicator

• Selfexpanding stent made of silicone with
  polyester mesh

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Indications

• stenosis of the central airways (trachea and main
  bronchus)
• compression or stricture due to tumours (trachea
  and main bronchus)
• esophagotracheal/-bronchial fistulas

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Stenosis
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new POLYFLEX-Stent
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Contraindications

• none in the case of vital indication
• obstruction to passage at laryngeal level
• bilateral recurrent laryngeal nerve paresis

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Relative Contraindications

• tracheomalacia
• benign operable stenosis

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Applicator System

• Introducer sleeve
• Stent loader/positioner
• blue/white stopper

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Available Sizes

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Sizes DUMON-Stent
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Characteristics

• Silicone coating throughout
• prevents ingrowth of tumour tissue
• closes tracheo-oesophageal and broncho-oesophageal
  fistulae

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Characteristics

• Mesh structure of the outer surface of the
• stent
• increases security against dislocation

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Characteristics

• Smooth inner surface
• hinders encrustation with secretions

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Characteristics

• Uniform gentle resilience
• adapts elastically to the anatomy of the airways
• for inner support of the trachea and bronchi
• reduces tissue compression to a minimum

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Characteristics

• Reduction of cross section when stretched
  lengthwise
• allows simple change of stent

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Characteristics

• Thin wall
• suitable for stent-in-stent insertion

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Characteristics

• Broad range of widths and lengths
• can be coordinated for each indication and
  anatomical situation

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Characteristics

• Radiopaque insertion set
• facilitates precise positioning and monitoring of
  use

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THE IMPROVED POLYFLEX-STENT

• Silicone reinforcement protects the edges
• less stimulation for granulation

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THE IMPROVED POLYFLEX-STENT

• X-ray marker
• improved visibility during placement and
  post-operative follow-up

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THE IMPROVED POLYFLEX-STENT

• Modified mesh geometry
• optimized radial force
• easier application of the stent

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Biomechanics tracheobronchial Stents
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Biomechanics tracheobronchial Stents
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• Dumont Stent

Noppent Stent
POLYFLEX Stent (first version)
POLYFLEX Stent (new version)
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• Ultraflex Stent

Gianturco Stent
Wallstent
New Nitinol Stent
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TYPES OF STENOSIS (1/8)

• exophytic tumor

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TYPES OF STENOSIS (2/8)

• granulation

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TYPES OF STENOSIS (3/8)

• floppy membrane

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TYPES OF STENOSIS (4/8)

• compression

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TYPES OF STENOSIS (5/8)

• hour glass

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TYPES OF STENOSIS (6/8)

• scabbard trachea

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TYPES OF STENOSIS (7/8)

• stricture

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TYPES OF STENOSIS (8/8)

• web stenosis

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Patient preparation

• The patient must be adequately anaesthetized with
  an appropriate degree of relaxation
• The position is the same as for conventional
  intubation

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Selection of Polyflex stent size - Diameter

• The inner diameter of the Polyflex stent should
  be about 2 mm bigger than the main bronchus and
  about 4 mm bigger in the tracheal area than the
  measured diameter of the lumen of the healthy
  bronchus or trachea!

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Selection of Polyflex stent size - Length

• The Polyflex stent must extend beyond the
  stenosis at both ends by up to 10 mm.
• Please note that the stent is longer when
  compressed than when completely stretched!
• Do not shorten the Polyflex stent!!

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Preparation of the stent 1

• Moisten the outer surface of the Polyflex stent
  with commercially available aqueous lubricant
• Do not use mineral oil-based lubricants, silicone
  oils, silicone sprays or other silicone-containing
  agents!

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Preparation of the stent 2

• To insert the stent in the introducer sleeve,
  stretch the stent loader by pushing it back
• Insert the stent about halfway into the basket

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Loading the Stent (1)

• Pull the stent with the basket into the
  introducer sleeve, guiding in the stent without
  pressure

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Loading the Stent (2)

• Pull the stent in until only about 2 mm of it
  projects from the transparent introducer sleeve

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Loading the Stent (3)

• Use the blue stopper to secure the stent in the
  introducer sleeve so that it cannot be inserted
  any further

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Loading the Stent (4)

• Pull the loader off the stent by pulling it
  backwards
• The stent must be pushed fully into the
  introducer sleeve after the loader is removed

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Loading the Stent (5)

• Remove the loader and reinsert its other end in
  the introducer

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Insertion of stent (1)

• The introducer sleeve holding the Polyflex stent
  can be advanced through the rigid bronchoscope
  (without distal light source) as far as the
  distal end of the stenosis
• The Polyflex stent and the distal end of the
  positioner can be seen radiographically

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Insertion of stent (2)

• The transparent introducer sleeve is held at its
  upper end where it is reinforced with netting and
  is withdrawn over the positioner

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Insertion of stent (3)

• The positioner must be held in position!

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Insertion of stent (4)

• Kleinsasser technique
• The Kleinsasser operating laryngoscope is an
  alternative to the rigid bronchoscope (continuous
  ventilation)

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Insertion of stent (5)

• This illustration shows the correct position of
  the stent
• The released stent can be moved proximally if
  necessary using an atraumatic grasping forceps

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BENIGN TRACHEAL STENOSISsplinted with
POLYFLEX-STENT
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Removal of the Polyflex stent

• The Polyflex stent narrows when under traction.
• Because of this, the stent can be removed with an
  atraumatic foreign body forceps by pulling it
  back slowly and carefully

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Questions and Answers 1

• The POLYFLEX-STENT is placed too distally...

• The POLYFLEX-STENT can be withdrawn proximally
  under careful traction using an atraumatic
  foreign body forceps (universal jaws).

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Questions and Answers 2

• The POLYFLEX-STENT is placed too proximally ...

• Pushing the POLYFLEX-STENT distally is not
  advisable because of the particular material
  characteristics of the netting material
  (squashing).
• Remove it and place it once more.

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Questions and Answers 3

• Can I shorten the POLYFLEX-STENT?

• NO! Do not shorten the POLYFLEX-STENT.(risk of
  mucosal damage by projecting netting fibres).

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Questions and Answers 4

• Can I use laser while the POLYFLEX-STENT is in
  place?

• NO! Protect POLYFLEX-STENT from direct laser
  bombardment.
• Magnetic resonance imaging and CT are possible