title: Percutaneous vascular stent implantation as treatment for central vascular obstruction due to fibrosing mediastinitis.
abstract: BACKGROUND
  Fibrosing Mediastinitis (FM) is a rare complication of infection with Histoplasma capsulatum that can lead to obstruction of pulmonary and systemic vasculature and large airways, often resulting in significant morbidity and mortality. Medical therapy is ineffective, and surgical intervention is often not feasible. Stent implantation offers a potential treatment for vascular obstruction due to FM, but this has not been well studied.
  
  
  RESULTS
  We conducted a retrospective review of all patients undergoing cardiac catheterization for FM. Anatomic site of stenosis and hemodynamic information before and after intervention, as well as clinical presentation and follow-up data, were recorded. From 1996 to 2008, 58 patients underwent cardiac catheterization for FM, with intervention performed in 40 (69%). A total of 77 stents were used to relieve 59 lesions (pulmonary artery=26, pulmonary vein=21, and superior vena cava=12). Significant reduction in pressure gradients (P<0.001) and increase in vessel caliber (P<0.001) were seen at all locations. Symptomatic recurrent stenosis requiring further intervention occurred in 11 patients (28%). Median time to recurrence was 115 months. Thirty-two (87%) of 37 patients for whom follow-up was available reported symptomatic improvement after stent placement.
  
  
  METHODS
  related complications occurred in 14 patients (24%). Overall mortality was 19%, with the majority of deaths in patients with bilateral disease. Among patients with bilateral disease, intervention was associated with improved survival at 5 years.
  
  
  CONCLUSIONS
  Percutaneous vascular stent implantation is an effective therapy for central vascular obstruction due to FM, providing significant relief of anatomic obstruction and sustained clinical improvement.
authors.affiliation: Vanderbilt University Medical Center, Division of Pediatric Cardiology, 2200 Children's Way, Ste 5230, Nashville, TN 37232-6602, USA. erin.albers@vanderbilt.edu
authors.forename: Erin L
authors.initials: EL
authors.lastname: Albers
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Pugh
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hill
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.forename: James E
authors.initials: JE
authors.lastname: Loyd
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Doyle
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000473:pathology* / Q000601:surgery*