Radiological interventions in anastomotic complications following lung transplantation

Purpose: Bronchial and arterial anastomotic stenoses are major complications after lung transplantation. Interventional techniques provide a definitive cure in certain cases. Material and methods: Three out of four patients had ischemia-related stenoses of the bronchial anastomoses postoperatively; one patient developed malacia of the bronchus main stem 1 year after transplantation. Four patients had stenoses of the arterial anastomoses, which resulted in hemodynamic instability and reduced perfusion of the graft. Results: Stent implantation in the bronchial anastomoses (n = 3) and in the main stem (n = 1) improved ventilation and oxygen saturation in all patients. The stents were incorporated by mucosal overgrowth, as demonstrated by endoscopy, as early as 6 weeks after implantation. Balloon dilatation (n = 3) and stent implantation (n = 1) were successfully per formed in 4 patients with stenoses of the arterial anastomoses. The mean transstenotic pressure gradient of 9.5 mmHg was reduced to 2.2 mmHg after angioplasty. Lung perfusion shifted towards the grafts, as shown by Tc-99m perfusion scans. Conclusion: The minimally invasive techniques of interventional radiology are very effective in the treatment of anastomotic complications after lung transplantation and may avoid surgery in certain cases.