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Published ahead of print on June 3, 2005, doi:10.1164/rccm.200410-1388OC
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American Journal of Respiratory and Critical Care Medicine Vol 172. pp. 768-771, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200410-1388OC

Short-Term Deployment of Self-Expanding Metallic Stents Facilitates Healing of Bronchial Dehiscence

Majid M. Mughal, Thomas R. Gildea, Sudish Murthy, Gosta Pettersson, Malcom DeCamp and Atul C. Mehta

Department of Pulmonary and Critical Care, and Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

Correspondence and requests for reprints should be addressed to Atul C. Mehta, M.B., B.S., The Cleveland Clinic Foundation, Pulmonary and Critical Care Medicine/Desk A90, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail: mehtaa1{at}ccf.org

Bronchial dehiscence after lung transplantation is difficult to treat and associated with high mortality. We describe our experience using self-expanding metallic stents to treat post–lung transplant bronchial dehiscence. From January 1995 to June 2004, 189 single and 118 double lung transplants were performed in our institution, totaling 425 at-risk bronchial anastomoses. Seven (1.6%) incidents of life-threatening bronchial dehiscence were treated with self-expanding metallic stents. The interval between transplant and diagnosis of dehiscence was 29.1 ± 18.5 days. All patients presented with respiratory distress, and three required mechanical ventilation. Self-expanding metallic stent placement resulted in complete bronchial healing. All three patients with respiratory failure requiring mechanical ventilation were successfully weaned after stent placement. In two later cases, the stents were electively removed after adequate healing of the dehiscence. Complications included stent migration (one patient) and in-stent stenosis (three patients). Two of these patients required repeat stent insertion after removal, due to bronchomalacia. In patients with life-threatening bronchial dehiscence, self-expanding metallic stents offer prospects for a successful outcome. Self-expanding metallic stents are known to be associated with significant granulation tissue formation, and this property provides a platform for healing of dehiscence and, in time, peribronchial soft tissue grows in to cover the defect, allowing stent removal.

Key Words: bronchial dehiscence • lung transplantation • metallic stents




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