Successful Treatment of Bronchial Dehiscence With Endobronchial Stent in Lung Transplantation

Abstract

Bronchial dehiscence in lung transplantation is still a significant and threatening cause of morbidity, even if several progresses have been made in this field. In the present report we discuss a case of incomplete dehiscence of the right bronchial anastomosis in a patient who underwent sequential double lung transplantation for bronchiectasis. This complication has been successfully treated with endobronchial stent positioning, with the aim to allow the healing of the anastomosis around a rigid endobronchial support and to prevent the airway stenosis. The usefulness of 3D spiral CT reconstruction of bronchial tree is also underlined, for its capacity to detect the dehiscence and to monitor the healing of this complication.

Endobronchial mucosal blanching due to a post-lung transplantation pulmonary artery stenosis

“…The left lung had a longer ischemia time than the right, which was implanted first, but both within the normal time frame. Also, longer ischemia time is not known to increase the need for endobroncheal (EB) stents [1] as a surrogate marker for ischemia-induced anastomosis problems, and, in our patient, the left airway anastomosis looked prefect on bronchoscopy. Vascular anastomosis complications after lung transplantation are rare, but cause significant morbidity [2,3].…”

Airway complications post lung transplantation

“…Chest X-rays can demonstrate findings, but are not reliable [43]. Chest CT is more useful for prognosticating, planning interventions, and monitoring healing after interventions [44]. Bronchial wall defects of 4 mm or less have excellent clinical outcomes [45].…”

“…Self-expanding metallic stents placed by fiberoptic bronchoscopy may be used for more severe necrosis to stimulate localized neoepithelialization [44,46]. For necrosis involving the bronchi with partial dehiscence, fibrin glue can be applied to the defect, usually followed by a bare metal stent.…”