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.