TP038 INTERESTING AND CHALLENGING CASES IN INTERVENTIONAL PULMONOLOGY / Thematic Poster Session Savior Stent: A Case of Tracheobronchial Silicone Stent Placement for a Patient with Dehiscence of Tracheal Flaps A Hassan1, S Farooqui2, S Gupta3, H Youness 4, F A Chaudry5; 1Internal Medicine/Pediatrics, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States, 2Pulmonary and Critical Care Medicine, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States, 3University of Oklahoma, Oklahoma city, OK, United States, 4Pulmonary and Critical Care Medicine, OUHSC, Oklahoma City, OK, United States, 5Interventional Pulmonology, University of oklahoma, OKC, OK, United States Corresponding author's email: ahmad-hassan@ouhsc.edu Tracheo-bronchial Y shaped stents are used to alleviate airway obstruction or cover Tracheo-esophageal fistulas (TEF) at the level of tracheal carina We present a unique case of two TEFs that were both successfully covered with the placement of a single Y stent in a critically ill patient, who had dehiscence of tracheal flaps A 59 year old woman was referred to our hospital for recurrent pneumonia and management of tracheo-esophageal fistula She had a past medical history of squamous cell carcinoma (SCC) of upper thoracic and distal cervical esophagus which was treated with chemo-radiotherapy She subsequently developed a tracheo-esophageal fistula in upper 1/3 of esophagus and underwent multiple esophageal stent placements; however, she continued to have symptoms of gastric reflux and aspiration with recurrent pneumonia After a multi-disciplinary meeting, the decision of esophagogastrectomy and TE fistula repair with a latissimus dorsi flap was made On post-op day 3, she became hypoxic on 4L Nasal canula(NC) requiring more oxygen support and had to be intubated She had significant airleak in her right chest tube, placed during surgery earlier Interventional Pulmonology was consulted for tracheal stent placement Airway evaluation showed defect on the carina extending from the uptake of the left main stem to the uptake of the right main stem and a second defect approximately 5cm from the carina (approx 3cm x 2cm) With a 14mm rigid bronchoscope, a 15-10-10 silicone stent was used After successful deployment of the stent, patient’s air leak in the chest tube resolved and the chest xray showed re-expansion of the right lung which was previously collapsed as shown in figure below.The historical evidence of airway stents dates back to 1915 Since then, stents have come a long way with better material and improved placement techniques There are two main types endobronchial stents, Silicone based and Self-expandable metallic stents (SEMS) A good stent is easier to place, less likely to migrate, offers good mucocilliary clearance, causes less granulation and the least amount of local trauma To this date, no stent has all these qualities Therefore, the choice of stent is individualized based on underlying etiology, risk factors and life expectancy.We used a silicone stent as it causes less trauma and offers good mucocilliary clearance.Our case was unique because the patient had developed two fistulas To the best of our knowledge, this is the only reported case where two TE fistula were successfully covered by a single stent This abstract is funded by: Self Am J Respir Crit Care Med 2021;203:A2217 Internet address: www.atsjournals.org Online Abstracts Issue