Open AccessShort-term Placement of Multiple Self-expandable Metallic Stents for the Treatment of Bilateral Bronchial Dehiscences Complicating Lung Transplantation
Author(s) -
Meltem Tor,
Ali I. Musani,
Colin T. Gillespie,
Steven Leh,
Robert M. Kotloff,
Daniel H. Sterman
Publication year - 2009
Publication title -
journal of bronchology and interventional pulmonology
Language(s) - English
Resource type - Journals
eISSN - 1944-6586
pISSN - 1948-8270
DOI - 10.1097/lbr.0b013e318191f00b
Subject(s) - medicine , surgery , lung transplantation , dehiscence , anastomosis , bronchoscopy , right main bronchus , bronchus , lung , granulation tissue , radiology , transplantation , self expandable metallic stent , complication , stent , respiratory disease , wound healing
Bronchial dehiscence after lung transplantation is a rare complication yet has high morbidity and mortality. The majority of the patients are not surgical candidates. We present the case of a 59-year-old man with bilateral lung transplantation for interstitial pulmonary fibrosis who was readmitted with symptoms of acute rejection and severe hypoxemic respiratory failure on day 14. Bronchoscopy showed bilateral bronchial anastomotic dehiscences. A computerized tomography scan showed evidence of significant peribronchial air collection in the pleural space and the mediastinum. Owing to a high predictive operative mortality, endobronchial management was planned, and 3 uncovered self-expanding metallic stents (Ultraflex, Boston Scientific Corp) were placed (in the left main stem bronchus, the anterior segment of the right upper lobe, and the right intermediate bronchus). At 5 weeks bronchoscopy showed complete healing of the dehiscences with granulation. The stents were then removed by rigid bronchoscopy. Three weeks after the stent removal a bronchoscopic examination showed a normal tracheobronchial tree except for a slightly narrowed right anastomosis. We conclude that short-term placement of uncovered self-expanding metallic stents provides a safe and minimally invasive option in the management of bilateral dehiscences.