2. Non-anastomostic Bronchial Stenoses after Lung Transplantation: Outcome of Endobronchial Stent Placement Geltner C. 1, Stein M. 1, Tagger M. 2, Bucher B. 1, Müller L LKH Natters, Dept. of Pulmonology, 6161 Natters, Austria 2 LKH Natters, Dept. Of Anesthesiology, 6161 Natters, Austria 3 Dept. of Cardiac Surgery, University Innsbruck, Austria
Aim:
Airway stenoses are well known after lung transplantation although most occur due to surgical problems of the bronchial sutures. We wanted to analyse the use of endobronchial stenting in stenoses not related to the bronchial anastomoses.
Methods:
We performed a retrospective analysis in 12 patients after bilateral lung transplantation with consecutive stent placement aside the bronchial anastomoses. The indication for stent implantation was central bronchial stenoses due to bronchomalacia, granulation tissue with bronchial wall destruction and endoluminal stenosis with airflow limitation or occurrence of segmental or lobar atelectasis. We used Boston Ultraflex (23/26), Rüsch Polyflex (2/26), Rüsch Dynamic (1/26) stents.
Intermediusstenosis pre and post dilatation und stent placement (Pat 3)
Stenosis of left lower lobe and bronchomalacia pre and post dilatation and stent placement (Pat 2)
Results:
In 12 lung allograft recipients we implanted in total 26 stents between 2 and 72 month after bilateral lung transplantation. The predominant locations were the right (20%) and left lower lobe bronchus (25%) and the bronchus intermedius (33%). The patient had granulation tissue proliferation due to ischemia and/or chronic bacterial or fungal bronchitis. Only one patient had concomitant anastomoses dehiscence. The stents remained in situ from 1 day to 850 days after placement. In 18/26 stent placements no severe complications occurred. Stent migration was observed in 6/26, severe granulation tissue that revealed further interventional treatment in 4 patients. One patient died because of necrotizing vasculitis and letal hemoptysis. All other stents are still in place (10/26), were in place at the time of death due to other reasons (4/26) or were explanted regularly (5/26).
Stenosis of bronchus intermedius due to bronchomalacia (Pat 10)
Left lower lobe with MRSA and aspergillosis (Pat 4)
Table: Characteristic of patients and stents
Left lower lobe and left upper lobe stenosis (Pat 6)
Conclusion:
Endobronchial stent placement is an effective treatment for bronchial stenoses that are not related to the bronchial anastomoses. Complications occurred in about 40% of all stents.
Explanted stent