PURPOSE:Self Expanding Metallic Stents have been used to maintain airway patency in patients who are poor surgical candidates due to limited life expectancy or multiple co-morbidities. SEMS have been associated with a variety of complications yet broncho-vascular fistulas have rarely been reported.
METHODS:Retrospective study, tertiary care center. Review of charts of patients who developed broncho-vascular fistulas following SEMS placement between 1999 and 2007 using Wallstent or Ultraflex(Boston Scientific, Natick MA) stents.
RESULTS:During the study period,6 patients were diagnosed with broncho-vascular fistula formation. Indications for stent placement were airway obstruction caused by neoplasia in two patients and airway complications of lung transplantation in the other four. Diagnosis of broncho-vascular fistula was suspected from the CT scan findings or when the patients presented with massive hemoptysis. Male to female ratio was equal, mean age of patients at time of stent placement was 51.3 years (range 24–73 years). Median duration of interval between the stent placement and the diagnosis of broncho-vascular fistula was 16 months (range 1–65 months). Five of these patients died withing hours with massive hemoptysis following the diagnosis while one is still alive at 65 months.
CONCLUSION:SEMS should only be used in a select sub-group of patients, after exhaustive evaluation of other treatment options and require sequential follow-up to monitor for any complications. The cases presented here provide evidence that broncho-vascular fistulas can develop at any time after SEMS implantation for both benign and malignant conditions involving the major airways. Broncho-vascular fistula formation is invariably fatal thus suggesting the need for a more cautious approach especially in using SEMS for long term management.
CLINICAL IMPLICATIONS:To highlight a potentially fatal complication of broncho-vascular fistula formation from Self Expanding Metallic Stents.
DISCLOSURE:Chirag Choudhary, No Financial Disclosure Information; No Product/Research Disclosure Information