title: Effective treatment of post-pneumonectomy bronchopleural fistula by conical fully covered self-expandable stent.
abstract: The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical self-expandable stent for the treatment of post-pneumonectomy bronchopleural fistula (PPBPF). Between April 2008 and November 2010, six patients underwent treatment for the PPBPF by the introduction of a tracheobronchial conical fully covered self-expandable nitinol stent with the aim of excluding the bronchial dehiscence from the airflow. We secured the prosthesis to the tracheal mucosa with titanium helical fasteners tacks. Five patients presented with a bronchial fistula larger than 5 mm following right (4) or left (1) pneumonectomy. One patient had an anastomotic dehiscence after right tracheal sleeve pneumonectomy. A chest tube showed the absence of empyema in all cases. Immediate resolution of the bronchial air leak was obtained in all the patients. Permanent closure of the bronchial dehiscence without recurrence was achieved in all the patients at a mean follow-up time of 13 months (range 3-32). The bronchial stent was successfully removed in all patients without sequelae 71-123 days after its implantation. The use of the conical self-expandable Silmet(®) stent has proved to be an effective, safe and fast method to treat even large PPBPFs.
authors.affiliation: Department of Thoracic Surgery, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy. claudioandreetti@libero.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Andreetti
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Andrilli
authors.forename: Mohsen
authors.initials: M
authors.lastname: Ibrahim
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ciccone
authors.forename: Giulio
authors.initials: G
authors.lastname: Maurizi
authors.forename: Antonio
authors.initials: A
authors.lastname: Mattia
authors.forename: Federico
authors.initials: F
authors.lastname: Venuta
authors.forename: Erino A
authors.initials: EA
authors.lastname: Rendina
mesh_terms: D000368:Aged; D000497:Alloys; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000009:adverse effects / Q000295:instrumentation*; D020878:Device Removal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011013:Pneumonectomy / Q000009:adverse effects*; D011474:Prosthesis Design; D011859:Radiography; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012384:Rome; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000497:Alloys; C013616:nitinol