Endovascular Management of Early Lung Transplant–Related Anastomotic Pulmonary Artery Stenosis

• Published in: Journal of vascular and interventional radiology Vol. 26; no. 6; pp. 878 - 882
• Main Authors: Anaya-Ayala, Javier E., Loebe, Matthias, Davies, Mark G.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Adult; Aged; Angioplasty, Balloon - adverse effects; Angioplasty, Balloon - instrumentation; Angioplasty, Balloon - mortality; Arterial Occlusive Diseases - diagnosis; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - mortality; Arterial Occlusive Diseases - physiopathology; Arterial Occlusive Diseases - therapy; Constriction, Pathologic; Female; Humans; Lung Transplantation - adverse effects; Lung Transplantation - mortality; Magnetic Resonance Angiography; Male; Middle Aged; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; Pulmonary Artery - surgery; Radiography; Radiology; Recurrence; Retrospective Studies; Risk Factors; Stents; Texas; Time Factors; Treatment Outcome; PA; PAS; pulmonary artery stenosis; pulmonary artery
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2015.02.017

To report the safety and short-term efficacy of endovascular interventions for symptomatic lung transplant–related anastomotic pulmonary artery stenosis (PAS). From February 2008 to December 2011, 354 lung transplants were performed. Pulmonary arteriography was performed in 19 patients (63% men; age, 57 y ± 21, mean ± SD; seven double-lung transplants) because of respiratory decompensation (mean 6.7 mo after transplant). Seven arteriograms were normal, and 12 showed significant PAS. One patient (5%) underwent angioplasty alone, and 11 patients (57%) underwent stent placement. All patients underwent general anesthesia, and femoral access was used for the intervention. Technical success was 100% in the 12 patients treated. Symptoms improved in all patients who underwent intervention, with resolution in 11 of 12 (92%). There were no major or minor complications. Three patients (16%) had recurrent symptoms after discharge secondary to chronic rejection or pneumonia. Two patients died as a result of sepsis and multiorgan failure at 2 days and 14 days, respectively, after undergoing only pulmonary arteriography. In-stent stenosis occurred in 1 (9%) patient who required additional stent placement. During a mean follow-up period of 11 months, the remaining stents were patent, and the patients were asymptomatic. Endovascular stent placement provides an alternative to open repair for transplant-related anastomotic PAS. It has low mortality and morbidity rates, and it has shown excellent short-term functional and anatomic outcomes.