D24-15 Custom Y-stent Utilization in a Unique Tracheobronchomalacia Patient

Introduction Custom stents are a fast-evolving and revolutionary therapy for use in patients who require therapeutic stenting options due to a variety of tracheal, bronchial, and parenchymal diseases. The combination of increasing high-resolution CT imaging with 3-D printing technology has allowed for even greater flexibility in therapeutic treatment. Returned mesh is a well-described phenomenon in the medical literature and can create a wide variety of difficult to manage complications. Description The patient is a 64-year-old male with a past medical history of tracheobronchomalacia status post tracheoplasty with prolene mesh placement in April 2011 which was complicated by erosion of mesh through the membranous airway in April 2017. He subsequently underwent a right thoracotomy with a muscle flap reconstruction of the membranous trachea in May 2017. This was then complicated by a diverticulum of the distal trachea that was non-communicative with the esophagus and chronic stenosis of the left mainstem bronchus with residual mesh retained in the posterior membranous left mainstem bronchus. He had a custom Y-stent placed for the first time in February 2022 due to persistent sensation of shortness of breath along with productive cough. He experienced immediate relief after placement of his custom stent and has since demonstrated remarkable stability, rarely requiring unscheduled bronchoscopy for mucous clearance. He has nonetheless derived immense benefit from stenting from a symptomatic standpoint since initial placement in 2022. Discussion Customized stents utilizing 3-D printing technology have allowed far more flexibility to the clinical approach of patients with complex airway pathology. As tracheal and bronchial reconstruction surgeries continue to involve more complicated management modalities, including the use of mesh, complications will continue to arise. Mesh erosion is a potentially devastating complication from tracheobronchoplasty. It will, therefore, be important to facilitate treatment of complications from these and other modalities. Therapeutic bronchoscopy with custom stent placement will almost certainly continue to evolve as an effective tool in the management of patients such as these. This abstract is funded by: None