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Titolo:
Refractory post-transplant airway strictures: successful management with wire stents
Autore:
Lonchyna, VA; Arcidi, JM; Garrity, ER; Simpson, K; Alex, C; Yeldandi, V; Bakhos, M;
Indirizzi:
Loyola Univ, Med Ctr, Dept Thorac & Cardiovasc Surg, Maywood, IL 60153 USALoyola Univ Maywood IL USA 60153 & Cardiovasc Surg, Maywood, IL 60153 USA
Titolo Testata:
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
fascicolo: 6, volume: 15, anno: 1999,
pagine: 842 - 849
SICI:
1010-7940(199906)15:6<842:RPASSM>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
SINGLE-LUNG TRANSPLANTATION; BRONCHIAL ANASTOMOTIC COMPLICATIONS; STENOSIS; REVASCULARIZATION; DILATATION; DIAGNOSIS; PLACEMENT; BALLOON;
Keywords:
lung transplantation; bronchial stricture; wire stents; silicone stents; balloon dilation; airway complication;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
36
Recensione:
Indirizzi per estratti:
Indirizzo: Lonchyna, VA Tulane Univ, Med Ctr, Dept Surg, SL22,1430 Tulane Ave, New Orleans, LA 70112 USA Tulane Univ SL22,1430 Tulane Ave New Orleans LA USA 70112 USA
Citazione:
V.A. Lonchyna et al., "Refractory post-transplant airway strictures: successful management with wire stents", EUR J CAR-T, 15(6), 1999, pp. 842-849

Abstract

Objective: Bronchial stenosis, malacia and dehiscence are major airway complications of lung transplantation. Our success in managing this problem evolved from the use of semi-rigid dilators, to balloon dilation and placement of a stent, which were initially silicone, thereafter win balloon-expandable and finally wire self-expandable. Methods: From May, 1994 until July 1997, we performed a total of 49 single and 58 bilateral lung transplants. Symptoms of shortness of breath, verified by a drop in the forced expiratory volume in one second (FEV1), led to bronchoscopic inspection of the airway in lung transplant patients. Eighteen patients (16%) suffered a severe formof airway complication (dehiscence or stenosis) in 24 of 151 airways at risk (15.9%). These anastomotic strictures were recalcitrant to conventional therapy. Intervention consisted of rigid bronchoscopy, dilation of the stricture and placement of a stent. Flexible bronchoscopy and fluoroscopy were used for precise placement of the stent. As the initial stent, the Hood silicone stent was placed five times in four patients and the Dumont studded stent five times in four patients. The Palmaz wire stent was used as the initial stent 10 times in seven patients and the Wallstent used eight times inseven patients. Four patients had multiple stents, Balloon inflation moulded the wire stent to the airway. Results: There was no mortality resulting from the airway complication or any intervention. The most serious complication was a perforation of the airway using the semi-rigid dilator that necessitated immediate thoracotomy and re-anastomosis of the bronchus, Other complications necessitated repeat interventions due to restenosis or failure of the stents. The success of the stent placement was measured subjectivelyby the immediate ease of breathing enjoyed by each patient and objectivelyby the significant increase of the FEV1 from a pre-operative mean of 1.19 l (SD 0.64 l) to a post-operative mean of 2.06 l (SD 0.70 l) (P < 0001). The mean number of interventions according to the type of wire stent first used was significantly fewer with Wallstent insertion (1.28 (SD 0.48)) than in those patients in whom a Palmaz stent was inserted (5.22 (SD 2.38)) (P < 0008). Conclusion: The airway complication of stricture, broncho-malacia ordehiscence following lung transplantation can be managed effectively and easily with the use of balloon catheter dilation followed by precise placement of a self-expandable wire stent. The Wallstent is the superior stent forthis application. (C) 1999 Elsevier Science B.V, All rights reserved.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 23/09/20 alle ore 16:03:32