Endoscopic Treatment of Main Airway Disruption

Background: Airway complications continue to be an important source of morbidity and mortality after lung transplantation (LT). We report our experience with the endoscopic management of major airway disruption in patients who undergo LT. Methods: Between March 2002 and 2003, 22 patients underwent LT at our institution. Three patients developed post-LT airway complications, including dehiscence and iatrogenic disruption, after a bronchoscopic procedure. Retrospective review of medical records of these patients was carried out, especially paying attention to their management and outcomes. Results: Dehiscence of the right main bronchus was effectively managed in 1 patient using a self-expandable metallic stent (SEMS). Two other patients developed bronchial stenosis in a left and a right main bronchus, respectively, and a false passage formation after an endobronchial procedure, and also underwent self-expandable metallic stent (SEMS) placement. The stents were removed without any difficulty 1 month after their placement in 2 cases. In the third case, laser photoresection was required to vaporize granulomatous tissue to free the stent before its removal at 9 months. Airway patency was restored in all patients. Conclusions: Self-expandable metallic stent placement in patients who developed main airway disruption after LT is safe and effective and represents an alternative to more invasive procedures. The stent should be removed as soon as adequate healing has taken place.