When do you pursue interventional treatments in a lung transplant patient with anastomotic dehiscence complicated by a bronchopleural fistula?

Very small areas of dehiscence are typically managed conservatively with serial bronchoscopy for observation. However, for larger areas of dehiscence associated with a higher risk of mediastinal or pleural infection, we typically opt for mechanical debridement and airway stent placement to cover the defect in the anastomosis. We then re-evaluate the patient at 2 to 3 months after for stent revision or removal. It's important to note that airway stents come with complications, so we only deploy them when deemed necessary.