Interventional Bronchoscopy for the Management of Airway Complications Following Lung Transplantation

Chhajed, Prashant N.; Malouf, M.A.; Tamm, Michael; Spratt, Phillip; Glanville, Allan R.

doi:10.1378/chest.120.6.1894

Cited by 127 publications

(80 citation statements)

References 17 publications

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“…The use of metallic and silicone stents for benign airways has also been described previously in lung transplant patients with malacia and showed improvement in spirometry values [35]. Besides, the short-term (<30 days) complications of metallic stents in transplant patients with airway dehiscence were mucus plugging in 11.5% and stent migration in 3.3% of patients [36].…”

Section: Discussionmentioning

confidence: 82%

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Majid

Alape²,

Kheir³

et al. 2016

Respiration

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Background: Patients with severe symptomatic expiratory central airway collapse (ECAC) undergo a stent trial to determine whether they are candidate for tracheobronchoplasty. Most stent trials were done using silicone stents. However, there was a higher number of silicone stent-related complications. Objectives: The aim of this study was to evaluate the safety and efficacy of short-term uncovered self-expanding metallic airway stents (USEMAS) in patients with ECAC. Methods: This was a retrospective review. Baseline measurements were compared to those obtained after 7-14 days. Measurements included: Modified Medical Research Council (mMRC), Cough Quality of Life Questionnaire (CQLQ), spirometry testing, and 6-Minute Walk Test (6MWT). Stent- and procedure-related complications were reported. Results: 33 patients (median age, 52 years) underwent the USEMAS trial. Presenting symptoms were dyspnea in 100%, intractable cough in 90.3%, recurrent infection in 42.2%, and inability to clear secretions in 21.4%. Dyspnea, cough, and secretion clearance improved in 88, 70, and 57%, respectively. Overall, there was a significant improvement in mMRC (p < 0.001), CQLQ (p = 0.015), and 6MWT (p = 0.015). There was 1 airway infection, 1 stent migration, and 1 pneumothorax. The median duration of USEMAS was 7 days. All stents were removed without any complications. At the time of stent removal, no granulation tissue was observed in 30.9%, and mild granulation tissue was observed in 69.1%. Conclusion: The short-term USEMAS trial improves respiratory symptoms, quality of life, and exercise capacity with few complications in patients with severe symptomatic ECAC when performed by a multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population.

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Section: Discussionmentioning

confidence: 82%

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Majid

Alape²,

Kheir³

et al. 2016

Respiration

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“…Airway complications may present significant problems after lung transplantation despite improvements in graft preservation and surgical techniques [1,2,3]. The major cause of airway complications is related to airway ischaemia, as the donor bronchus is dependent on collateral perfusion from the pulmonary circulation since the bronchial arteries are usually not revascularized.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of centres that have published their results have chosen self-expandable metal stents to treat post-transplantation airway complications [1,2,6,7,8,9]. These stents are easy to deploy using flexible bronchoscopy and fluoroscopy; they are flexible, and can be used almost regardless of airway anatomy as they conform well to distortions and curves within the airway [10].…”

Section: Introductionmentioning

confidence: 99%

Airway Complications after Lung Transplantation: Long-Term Outcome of Silicone Stenting

Sundset¹,

Lund²,

Hansen³

et al. 2012

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Background: Airway complications remain a significant cause of morbidity after lung transplantation. The majority of the centres that have published their results have used metal stents. Objectives: We report the long-term outcome of silicone stenting and subsequent stent removal in lung transplant recipients with stenotic airway complications. Method: From 1990 to 2008, 279 patients received 88 single, 170 double, and 21 heart-and-lung transplantations. Of 470 anastomoses at risk, 44 airway complications developed and were treated in 35 patients. Six lesions were treated with Nd:YAG laser and balloon dilatations only. Thirty-two silicone stents of Hood or Dumont type were inserted in 27 patients. Results: Symptoms were relieved and FEV₁ increased in all patients (median 0.7 litres, range 0.1-1.8 litres, p < 0.0001). In 8 patients, stents had to be repositioned or reinserted, in 19 patients only one insertion and one removal procedure were necessary. One patient suffered a serious complication with haemorrhage and pneumonectomy, 3 patients had minor airway wall injuries resolving spontaneously. Six patients died with the stents from causes not related to the airway complications. Twenty-five stents could be removed after a median of 6 months (range 1-22) in 21 patients, and 22 airways remained patent. Median FEV₁ was 2.3 litres immediately after stent removal, and remained 2.3 litres after 24 months. Conclusion: Stenotic airway complications after lung transplantation can be successfully treated with silicone stents, which can ultimately be removed, leaving a patent airway.

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“…Prevalence of AS after lung transplantation is 5-20 % with an associated mortality of 2-4 % [3]. Most [4][5][6]. According to the standard technique, a guidewire is passed across the stenotic lesion into a distal bronchus under fluoroscopic and endoscopic guidance, and a bronchial dilation and/or stent placement is performed to follow.…”

Section: Introductionmentioning

confidence: 99%

Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach

Miraglia

Vitulo

Maruzzelli

et al. 2015

Cardiovasc Intervent Radiol

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Airway stenosis is a major complication after lung transplantation that is usually managed with a combination of interventional endoscopic techniques, including endobronchial debridement, balloon dilation, and stent lacement. Herein, we report a successful case of recanalization of a complete stenosis of the right middle lobe bronchus in a lung transplant patient, by using a combined percutaneous–bronchoscopic approach after the failure of endobronchial debridement.

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Interventional Bronchoscopy for the Management of Airway Complications Following Lung Transplantation

Cited by 127 publications

References 17 publications

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Airway Complications after Lung Transplantation: Long-Term Outcome of Silicone Stenting

Successful Recanalization of a Complete Lobar Bronchial Stenosis in a Lung Transplant Patient Using a Combined Percutaneous and Bronchoscopic Approach

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