Efficacy of Bronchoscopic Closure of a Bronchopleural Fistula with Amplatzer Devices: Long-Term Follow-Up

Abstract

Background: The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. We have developed a minimally invasive method of bronchoscopic BPF closure using Amplatzer devices (AD) and Amplatzer vascular plugs (AVP), with excellent short-term results. Objectives: The aim of the present report was to explore the long-term outcome of patients treated by Amplatzer occluders and the durability of this novel modality of BPF treatment. Methods: A total of 31 central BPF in 31 patients (mean age 66.8 years, range 19-91) were sealed under moderate sedation bronchoscopically by either AD (n = 19) or AVP (n = 12). The average follow-up period was 17.6 months (range 1-68 months). Results: The main etiology for BPF was surgery (n = 24), pneumonectomy (n = 14) or lobectomy/segmentectomy (n = 10). The underlying disease was either primary (n = 19) or metastatic (n = 2) lung cancer. The immediate success rate was 96% as symptoms related to BPF disappeared in 30 of the 31 patients. Short-term (<30 days) mortality was 13% (4 patients). At follow-up, 14 patients (45%) are still alive. Out of 12 patients with late mortality, in 5 patients (41%) the death was directly related to cancer relapse, and no patient died due to BPF recurrence. Conclusion: Endobronchial closure of BPF using both types of Amplatzer occluders (AD and AVP) is a minimally invasive effective modality of treatment with high safety profile and satisfactory long-term outcome considering the poor prognosis in this particular group of patients.

Modified Silicone Stent in the Treatment of Bronchopleural Fistula: Clinical Observation of 17 Cases

“…The utility of these materials was restricted to small BPFs (< 3 mm in size). The other strategy is occlusive devices, mainly included: stents and their modi cations, Amplatzar™ devices [24,25], endobronchial valves (EBVs) [26], and the endobronchial Watanabe spigot (EWS) [27]. However, many of these are expensive or not routinely available in developing countries.…”

Minimally invasive closure of bronchopleural fistulae with novel closure devices: Fantasy or reality?

“…[4][5][6][7][8][9][10] After the introduction of patent foramen ovale and atrial septal defect closure devices, such as the Amplatzer (St. Jude Medical, St. Paul, Minn) and Occlutech Figulla (Occlutech, Helsingborg, Sweden), reports began surfacing that use these or similar individually constructed devices in the transbronchial closure of BPFs. [9][10][11] For instance, Fruchter and colleagues 11 reported successful closure of BPF in 30 of 31 patients using the Amplatzer devices and vascular plugs. In the current report, Lin and colleagues 12 describe a modified ''occluder'' that is similar to patent foramen ovale/atrial septal defect occluders and previously reported modified nitinol stents (Figure 1, A); however, they describe a bare metal mid-portion used for better anchoring-a potential benefit.…”

Endoscopic bronchial valve closure for lung diseases

“…Существует множество способов прекращения утечки воздуха (ригидная трахеобронхоскопия, окклюзия бронха окклюдорами различных конструкций, обработка клеевыми композициями свищевого хода). При отсутствии эффекта прибегают к повторным вмешательствам [5][6][7][8][9][10].…”