Treatment of complex airway lesions after lung transplantation with self-expandable nitinol stents: early experience.
Airway complications (AC) are considered a serious cause of morbidity after lung transplantation (LT). Mechanical dilatation, laser vaporization, and silicone stent placement usually solve it. However, the use of self-expandable metallic stents (SENS) may be indicated in selected cases. Ten lung transplant recipients with AC were treated with SENS. Six patients underwent LT for cystic fibrosis, 2 for idiopathic pulmonary fibrosis, 1 for bronchiectasis, and 1 for emphysema. All patients received at least 1 treatment attempt with dilatation and silicone stent placement. The indications for SENS placement were the presence of a tortuous airway axis with stenosis and malacia of the right main bronchus in 5 patients; a long stenosis of the main and intermediate right bronchus involving the upper lobe orifice in 3 patients; or malacia that could not be stabilized with silicone stents in 3 cases. In 1 patient the procedure was bilateral. Functional improvement was immediate with a mean forced expiratory volume at 1 second (FEV(1)) gain of 35%. No stent dislocation was observed. Symptoms did not occur again in 5 patients with previous recurrent episodes of pneumonia. One stenosis, which was due to the ingrowth of granulation tissue occurred at 6 months after the procedure, was successfully treated with mechanical dilatation and laser vaporization. The deployment of SENS in a selected group of patients with AC after LT was easy, safe, and effective.
Department of Thoracic Surgery, University of Rome Sapienza, Sapienza, Italy. marco.anile@uniroma1.it
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M
Anile
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F
Venuta
D
D
Diso
V
V
Liparulo
C
C
Ricella
T
T
De Giacomo
F
F
Pugliese
M
M
Rolla
S
S
Quattrucci
Y
Y
Pecoraro
E A
EA
Rendina
G F
GF
Coloni
D000497:Alloys; D003550:Cystic Fibrosis / Q000209:etiology / Q000601:surgery / Q000628:therapy; D004106:Dilatation / Q000379:methods; D004646:Emphysema / Q000209:etiology / Q000601:surgery / Q000628:therapy; D005541:Forced Expiratory Volume; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000601:surgery / Q000628:therapy; D012828:Silicones; D015607:Stents; D016896:Treatment Outcome
D000497:Alloys; D012828:Silicones; C013616:nitinol