[Radiologic interventions in anastomosis complications after lung transplantation].
OBJECTIVE
Bronchial and arterial anastomotic stenoses are major complications after lung transplantation. Interventional techniques provide a definitive cure in certain cases.


METHODS
Three out of four patients had ischemia-related stenoses of the bronchial anastomoses postoperatively; one patient developed malacia of the bronchus main stem 1 year after transplantation. Four patients has stenoses of the arterial anastomoses, which resulted in hemodynamic instability and reduced perfusion of the graft.


RESULTS
Stent implantation in the bronchial anastomoses (n = 3) and in the main stem (n = 1) improved ventilation and oxygen saturation in all patients. The stents were incorporated by mucosal overgrowth, as demonstrated by endoscopy, as early as 6 weeks after implantation. Balloon dilatation (n = 3) and stent implantation (n = 1) were successfully performed in 4 patients with stenoses of the arterial anastomoses. The mean transstenotic pressure gradient of 9.5 mm Hg was reduced to 2.2 mm Hg after angioplasty. Lung perfusion shifted towards the grafts, as shown by 99mTc perfusion scans.


CONCLUSIONS
The minimally invasive techniques of interventional radiology are very effective in the treatment of anastomotic complications after lung transplantation and may avoid surgery in certain cases.
Berger
H
H
Institut für Radiologische Diagnostik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern.
Steiner
W
W
Stäbler
A
A
Spelsberg
F
F
Müller
C
C
Dienemann
H
H
D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000628:therapy; D008168:Lung / Q000098:blood supply; D016040:Lung Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography; D015607:Stents; D014692:Ventilation-Perfusion Ratio / Q000502:physiology