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Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation.

Abstract：

STUDY OBJECTIVES:Bronchial stenosis (BS) and bronchomalacia (BM) are often associated with lung allograft rejection or infection in lung transplant (LT) recipients. We reviewed our experience using balloon-expandable metallic (Palmaz) stents in the management of BS and BM in LT. DESIGN:Retrospective review of cases. PATIENTS:LT recipients with bronchoscopic and spirometric evidence of BS and BM. INTERVENTIONS:Serial balloon dilation was performed for BS. Stent placement was done for refractory or recurrent BS, or persistent focal BM. RESULTS:Twelve of 129 LT bronchial anastomoses at risk (9.3%) had complications, which included 11 BS and 5 BM. Four BS were accompanied by BM either concurrently or subsequently. The only isolated BM was associated with acute rejection and resolved after appropriate medical therapy. Balloon dilations alone were successful in relieving BS in three cases. Seven patients received a total of 11 stents. Stents were placed under conscious sedation using a flexible bronchoscope. Five of the seven patients had spirometric improvements after stent placements. One patient had no spirometric improvement, and another died before a follow-up study was done. There were no complications during stent placements. However, complications after stent placements included partial dehiscence of the stent from the bronchial wall, stent migration, partial obstruction of a segmental bronchial orifice by a stent in the main bronchus, and longitudinal stent collapse. One stent was successfully removed using a flexible bronchoscope in the endoscopy suite, and two others were removed by rigid bronchoscopy in the operating room. CONCLUSIONS:Endobronchial placement of the Palmaz stent in LT recipients is relatively easy, and it can be removed if needed. However, because there are significant potential complications, the future use of this stent as an airway prosthesis in LT remains unclear.

journal_name

Chest

journal_title

Chest

authors

Susanto I,Peters JI,Levine SM,Sako EY,Anzueto A,Bryan CL

doi

10.1378/chest.114.5.1330

subject

Has Abstract

pub_date

1998-11-01 00:00:00

pages

1330-5

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(16)33069-0

journal_volume

114

pub_type

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Use of balloon-expandable metallic stents in the management of bronchial stenosis and bronchomalacia after lung transplantation.