Tracheal stenosis and obliteration above the tracheostoma after percutaneous dilational tracheostomy

Percutaneous dilational tracheotomy (PDT) as opposed to the conventional surgical tracheostomy is a procedure that allows airway control in critically ill patients without surgical exposure of the trachea. Based on the Seldinger technique, dilators are passed along a guiding wire through a small neck incision into the trachea under endoscopic surveillance. This separates the tracheal rings and results in a stoma. As opposed to the regular surgical tracheostoma, a PDT-stoma is not epithelialized. The procedure is cost effective and little time consuming. Considering the increasing number of performed PDTs in the last few years, we feel a need to be aware of possible long-term complications. Thus, in this report, we describe three cases of tracheal stenosis/obliteration after a PDT procedure. In all cases, tracheal narrowing occurred above the level of the stoma. This suggests a procedure-related mechanism, i.e., tracheal ring invagination and the consecutive development of granulation tissue, rather than a mechanism based on the duration of the cannula's placement, which would normally produce the stenosis below the stoma in the area of the cuff. Toward the end of the article, we provide evidence for this hypothesis and thus present a new subset of long-term complications after PDT.