Abstract
BackgroundAirway complications are among the most challenging problems after lung transplantation, and Self-Expandable Metallic Stents (SEMS) are used to treat airway complications such as stenosis or malacia at the bronchial anastomosis sites. Several transplantation centers are reluctant to use SEMS since their removal is sometimes needed and usually requires the use of rigid bronchoscopy under general anesthesia. The objective of the current report is to describe our experience in SEMS retrieval by flexible bronchoscopy under conscious sedation.MethodsA retrospective review was done of patients requiring tracheobronchial stent placement after lung transplantation in which the SEMS had to be removed. The retrieval procedure was done by flexible bronchoscopy on a day-care ambulatory basis.ResultsBetween January 2004 and January 2010, out of 305 lung transplantation patients, 24 (7.8%) underwent SEMS placement. Indications included bronchial stenosis in 20 and bronchomalacia in 4. In six patients (25%) the SEMS had to be removed due to excessive granulation tissue formation and stent obstruction. The average time from SEMS placement to retrieval was 30 months (range 16-48 months). The stent was completely removed in five patients and partially removed in one patient; no major complications were encountered, and all patients were discharged within 3 hours of the procedure. In all procedures, new SEMS was successfully re-inserted thereafter.ConclusionsThe retrieval of SEMS in patients that underwent lung transplantation can be effectively and safely done under conscious sedation using flexible bronchoscopy on a day-care basis, this observation should encourage increasing usage of SEMS in highly selected patients.
Highlights
Airway complications are a significant source of morbidity and mortality among lung transplantation patients
We wish to describe our experience in removing SelfExpandable Metallic Stents (SEMS) deployed in patients that underwent lung transplantation under conscious sedation using flexible bronchoscopy based techniques without the need for rigid bronchoscopy
All retrieval procedures were done by flexible bronchoscopy under moderate sedation via the transoral approach using a bite-block
Summary
Airway complications are a significant source of morbidity and mortality among lung transplantation patients. Self-Expandable Metallic Tracheobronchial Stents (SEMS) are inserted with increasing frequency in patients that underwent lung transplantation and developed airway complications such as anastomotic dehiscence, excessive refractory granulation tissue formation and stenosis at the bronchial anastomosis [5,6,7,8]. The main advantage of SEMS is the ease of their placement, a procedure that usually can be performed using flexible bronchoscope under conscious sedation. Another significant advantage is the low SEMS for treating airway complications in their high anesthetic risk patients [11,12,13]. We wish to describe our experience in removing SEMS deployed in patients that underwent lung transplantation under conscious sedation using flexible bronchoscopy based techniques without the need for rigid bronchoscopy. The objective of the current report is to describe our experience in SEMS retrieval by flexible bronchoscopy under conscious sedation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
