Here we report our experience in succession the use of balloon dilatation or self-expandable metal Wallstent implantation.

Here we report our experience in succession the use of balloon dilatation or self-expandable metal Wallstent implantation, or one as well as the other for the management of twelve bronchial stenoses in ten lung transplant recipients during the past sum of two units years. Both techniques were carried abroad endoscopically, under fluoroscopic guidance and without general anesthesia. the two methods were straightforward, well tolerated, and ensueed in immediate symptomatic and functional improvement. The first-line treatment relied in succession Wallstent insertion (n = 4) or upon balloon dilatation (n = 8) Early restenosis occurr in four of eight dilated stenoses and subsequently l to Wallstent insertion. Following Wallstent implantation, pullulation of granulation tissue occurred in common case and necessitated repeated balloon dilatations inside the during the following months. in succession two occasions, the stenosis was located as it was that the lower end of the Wallstent overlapped the upper lobe bronchus orifice. This necessitated laser therapy to eliminate the filaments of the crossing the lobar orifice, preventing after obstruction. Laser therapy was followed, in single in kind case, by a fibroinflammatory stenosis which was favorably treated by balloon dilatation inside the prosthesis. At the time of writing, the mean [+ or -] SE of the follow-up after Wallstent implantation is 153 [+ or -] 27 (range: 6 to 32) month mostly Wallstent prostheses are overgrown with bronchial epithelium. We infer (1) that self-expanding metal Wallstent implantation is a safe proceeding and good alternative to silicone insertion for the treatment of bronochostenosis following lung transplantation, provided granulomas are not instant and (2) that balloon dilatation, although possibly leading to returns can be used to allow inflammatory tissue to mature or to dilate restenoses inside the Wallstent.

After lung transplantation, the bronchial anastomotic site is at risk of ischemic complications.[1] Although new improvements in graft preservation and in surgical techniques have reduc their prevalence, airway complications remain a major vexed question after lung transplantation.[2-8] The aspects of airway ischemia to be addressed include dehiscence, necrosis, and stenoses with malacia, fibrous stricture formation, or prolific granulation or all three Cryoablation, laser photoresection, or dilatations with a rigid bronchoscope or all three have been propos for the relief of similar stenoses.[7,8] These latter proceedings can alleviate distressing symptoms nevertheless usually have only a short-term effectiveness. Therefore, posterior bronchial widening has been propos using silicone stents[2-46-9] Potential disadvantages of these s include their tendency to distal migration,[4,9] relatively unfavorable wall-to-lumen ratio with the associated risk of mucus retention,[5,9] and the possible inclination to stimulate formation of granulation tissue distal to the These limitations have l to a newly come interest in expanding metal s which offer greater flexibility than silicone tube prostheses, small surface area in contact with bronchial mucosa, progressive epithelialization, and minimal risk of occluding the bronchial orifice if misplaced.[10,11] There have been a certain reports on expandable metal s in the treatment of tracheobronchial airway strictures,[10,12-16] further they comprised a limited number of lung transplant recipients. A not long ago described limitation of expandable metal s has been granuloma formation inside the prosthesis in patients with fibroinflammatory stenosis.[12,16] In this regard, endobronchial balloon dilatation has been propos as a relatively noninvasive first-line treatment of fibroinflammatory stenoses following lung transplantation.[17-19] Here we describe our experience with balloon dilatation or the insertion of a self-expanding metal (Wallstent, Schneider Europe, Zurich, Switzerland) for the treatment of 12 bronchial anastomotic complications in 10 patients who received lung transplants.

manners AND PATIENTS

Balloon Bronchial Dilatation

Balloon dilatation was performed according to an adaptation of a system already described.[20] Briefly, we used a standard angioplasty body that included a 0.035-inch guidewire (145 m) a standard 5F catheter with a balloon (10 to 14 mm in diameter and 2 to 3 cm in length) a manometer, and a syringe containing a diluted contrast media (Iohexol). The exact position of the stenosis was established using a combination of endoscopic and fluoroscopic guidance. The fiberoptic bronchoscope was positioned above the stenosis, and metallic markers were placed in succession the skin, specifying the distal and proximal limits of the lesion. The guide was then inserted in consequence of the canal of the bronchoscope and past the lesion. Then the fiberoptic bronchoscope was remov and the balloon catheter present in place. The balloon was gradually inflated with Iohexol to its maximum dimensions, as visualized on fluoroscopy, and held inflated at 6 to 12 bars for 10 to 30 s depending on the clinical tolerance and connections on cutaneous oxygen saturation. At the close of the period of inflation, the balloon was rapidly deflated about 3 min to recruit before one or two further dilatations were performed.

...