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Lu H, Li Y, Ren K, Li Z, Liu J, Duan X, Ren J, Han X. Covered SEMS failed to cure airway fistula closed by an amplatzer device. BMC Pulm Med 2023; 23:270. [PMID: 37474964 PMCID: PMC10357874 DOI: 10.1186/s12890-023-02548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Airway fistula is a rare but threatening complication associated with high rates of morbidity and mortality. We report the experience of Amplatzer device application in airway fistulae that failed to be cured with a covered self-expandable metallic stent (SEMS). MATERIALS AND METHODS Patients who failed occlusion with a covered self-expandable metallic stent and received Amplatzer device placement from Jan 2015 to Jan 2020 were retrospectively enrolled. A total of 14 patients aged 42 to 66 years (55.14 ± 7.87) were enrolled in this study. The primary diseases, types of fistula, types of stents, duration, size of fistula, and follow-up were recorded. RESULTS All 14 patients with airway fistula failed to be occluded with a covered metallic stent and received Amplatzer device placement. Among the 14 patients, 6 had BPF, 3 had TEF and 5 had GBF. The average stent time was 141.93 ± 65.83 days. The sizes of the fistulae ranged from 3 to 6 mm. After Amplatzer device placement, the KPS score improved from 62.14 ± 4.26 to 75.71 ± 5.13 (P < 0.05). No procedure-related complications occurred. During the 1-month, 3-month and 6-month follow-ups, all the Amplatzer devices were partially surrounded with granulation. Only 1 patient with BPF failed with Amplatzer device occlusion due to the recurrence of lung cancer. CONCLUSION In conclusion, the application of the Amplatzer device is a safe and effective option in the treatment of airway fistula that failed to be occluded with SEMSs.
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Affiliation(s)
- Huibin Lu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Yahua Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Kewei Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Zongming Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Juanfang Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, PR China.
- Interventional Institute of Zhengzhou University, 450052, Zhengzhou, PR China.
- Interventional Treatment and Clinical Research Center of Henan Province, 450052, Zhengzhou, PR China.
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Bansal S, Furtado A, Kalpakam H, Loknath C, Mehta RM. A customized multimodality approach for prolonged air leaks (PAL) in mechanically ventilated patients. Respirol Case Rep 2023; 11:e01173. [PMID: 37383366 PMCID: PMC10293885 DOI: 10.1002/rcr2.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
ARDS in general and severe COVID ARDS (CARDS) is particularly associated with high rates of barotrauma. Two cases with severe CARDS developed bilateral pneumothorax with persistent air leak (PAL). Conservative management with prolonged chest tube drainage did not help in PAL resolution and both patients continued to be on high-end ventilatory support. The course was further complicated by the presence of septic shock. The 1st patient was taken up for a challenging procedure after spending 23 days on the mechanical ventilator. Diagnostic pleuroscopy revealed left-sided bullae and a surgical staple bullectomy was done. The right side showed a large bronchopleural fistula (BPF) on pleuroscopy, which was occluded using a customized endobronchial silicone blocker (CESB, described in 2018). This led to the reduction and finally, resolution of the bilateral PAL with subsequent removal of chest drains and weaning off the ventilator and oxygen. The second patient was managed with 2 CESB devices for occlusion of RUL anterior and posterior segment fistulae, followed by chest drain removal. These cases highlight effective out-of-the-box multimodality treatment using a combination of interventional pulmonary techniques and surgical stapling for a life-threatening bilateral PAL secondary to CARDS.
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Affiliation(s)
- Sameer Bansal
- Department of Pulmonary MedicineApollo HospitalsBangaloreIndia
| | - Arul Furtado
- Department of Cardiovascular & Thoracic SurgeryApollo HospitalsBangaloreIndia
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Bashour SI, Ost DE. An update on bronchopleural fistulae following cancer-related surgery. Curr Opin Pulm Med 2023; 29:223-231. [PMID: 37102602 DOI: 10.1097/mcp.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
PURPOSE OF REVIEW Bronchopleural fistulae (BPF) are rare complications in cancer-related surgery but impart significant morbidity and mortality. BPF may be difficult to identify, with a broad differential diagnosis at presentation, so it is critical to be aware of newer diagnostic and therapeutic approaches for this disease entity. RECENT FINDINGS Multiple novel diagnostic and therapeutic interventions are featured in this review. Reports of newer bronchoscopic techniques to localize BPF, as well as approaches for bronchoscopic management, like stent deployment, endobronchial valve placement, or alternative interventions when indicated are discussed, paying particular attention to factors that influence procedure selection. SUMMARY Management of BPF remains highly variable, but several novel approaches have shown improved identification and outcomes. Although a multidisciplinary approach is imperative, an understanding of these newer techniques is important to provide optimal care for patients.
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Affiliation(s)
- Sami I Bashour
- Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Aliaga F, Grosu HB, Vial MR. Overview of Bronchopleural Fistula Management, with a Focus on Bronchoscopic Treatment. CURRENT PULMONOLOGY REPORTS 2022. [DOI: 10.1007/s13665-022-00289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Seyhan EC, Turan D, Özgül MA, Uğur Chousein E, Özgül G, Çetinkaya E. Use of airway stents to treat malignant tracheobronchial fistulas: Our six-year experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2022; 30:216-226. [PMID: 36168571 PMCID: PMC9473597 DOI: 10.5606/tgkdc.dergisi.2022.20831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/08/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND This study aims to investigate the indications, safety, complications, and long-term outcomes of airway stenting in the treatment of malignant tracheobronchial fistulas. METHODS The medical records of a total of 34 patients (24 males, 10 females; mean age: 55.4+13 years; range, 23 to 76 years) with malignant tracheobronchial fistulas treated with airway stenting between February 2014 and August 2020 were retrospectively analyzed. Data including demographic features, diagnosis, symptoms, treatment, complications and outcomes were recorded. RESULTS Thirty-eight airway stents were inserted in 34 patients with malignant tracheobronchial fistulas, including 19 patients with malignant tracheobronchial esophageal fistulas and 15 patients with bronchopleural fistulas. The clinical success and the technical success rates were 91% and 100%, respectively. No perioperative death or severe complications occurred. Chronic complications (>24 h) occurred in eight (23%) patients with malignant tracheobronchial fistula. Median follow-up was 3.5 (range, 1.4 to 5.5) months in patients with malignant tracheobronchial esophageal fistulas and 18 (range, 9.5 to 26.5) months in patients with bronchopleural fistulas. Mortality rates were 79% and 61%, respectively. CONCLUSION Airway stent insertion provides a secure and effective treatment for patients with malignant tracheobronchial fistulas.
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Affiliation(s)
- Ekrem Cengiz Seyhan
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Demet Turan
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Mehmet Akif Özgül
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Efsun Uğur Chousein
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
| | - Güler Özgül
- Department of Chest Disease, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Türkiye
| | - Erdoğan Çetinkaya
- Department of Chest Disease, University of Health Sciences, Yedikule Training and Research Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Türkiye
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Han YM, Lee HB, Jin GY, Kim KY. Bronchopleural Fistula after Surgery: Therapeutic Efficacy of Bronchial Occluders. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:371-381. [PMID: 36238740 PMCID: PMC9431948 DOI: 10.3348/jksr.2020.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/19/2020] [Accepted: 06/16/2020] [Indexed: 11/15/2022]
Abstract
목적 수술 후 발생하는 기관지늑막루에 대한 bronchial occluder device (이하 BOD)의 유용성 및 효과성을 평가하고자 한다. 대상과 방법 2009년도부터 2019년까지 폐암 및 폐결핵으로 수술 후 발생한 7명의 기관지늑막루 환자들 중에 BOD 치료를 실시한 6명의 환자를 대상으로 하였다. 폐암 환자가 5명, 폐결핵 환자는 1명이었다. 남자가 5명, 여자가 1명이었으며 59세에서 74세(평균: 69세)이었다. 진단은 전산화단층기관지 촬영과 기관지내시경으로 실시하였다. 시술은 진단 후 1주에서 2주 사이에 실시하였다. 치료에 사용된 BOD의 기술적 성공 및 임상적 성공을 평가하였다. 시술 후 임상적 치료 효과와 생존 기간 및 부가적인 치료에 대하여 알아보았다. 결과 총 6명 환자 모두에서 시술을 성공적으로 실시하였다. 임상성공 5명에서 있었고, 1명에서는 임상부분성공이 있었다. 임상실패한 경우는 없었다. 기구의 이동이나 천공의 합병증은 없었다. 2명은 전산화단층기관지 촬영으로, 4명은 기관지내시경으로 기관지늑막루를 진단하였다. 수술은 폐엽절제술(lobectomy) 2명, 폐이엽절제술(bilobectomy) 2명, 그리고 전폐절제술(pneumonectomy) 2명이었다. 수술 후 진단까지 걸린 시간은 1개월에서 34개월(평균: 10개월)이었다. 4명(59~103일: 평균 80.5일)은 사망하였고 2명(313일, 3331일)은 생존하였다. 사망 원인이 2명은 기저질환의 악화, 1명은 폐부종 및 흉수, 1명은 폐렴이었다. 한 명에서 부가적인 카테타 배액술, 2명에서 흉관 삽입을 유지하였다. 결론 폐절제 수술 후 발생할 수 있는 기관지늑막루 치료에 있어서 BOD는 유용하고 효과적인 치료 방법이다.
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Affiliation(s)
- Young Min Han
- Department of Radiology, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
| | - Heung Bum Lee
- Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Department of Respiratory Allergy Internal Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
| | - Gong Yong Jin
- Department of Radiology, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
| | - Kun Yung Kim
- Department of Radiology, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
- Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University Hospital, Jeonju, Korea
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7
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Nishiyama A, Sakaguchi H, Yanagimura N, Suzuki C, Otani S, Tanimoto A, Yamashita K, Takeuchi S, Ohtsubo K, Ikeda H, Yano S. Bronchoesophageal fistula formation after three courses of nivolumab for carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma. Oxf Med Case Reports 2020; 2020:omaa116. [PMID: 33391772 PMCID: PMC7768526 DOI: 10.1093/omcr/omaa116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/24/2020] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are widely used in both monotherapy and combination chemotherapy for various types of cancers. Nivolumab is the most popular among ICIs, and the number of adapted malignant diseases for nivolumab is increasing. Bronchoesophageal fistula formation is a serious complication of the treatment for esophageal or lung cancer. However, the development of bronchoesophageal fistula as a complication of ICIs is obscure. A 59-year-old man who was diagnosed with carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma had bronchoesophageal fistula formation after three cycles of nivolumab as the fourth line treatment. Before the initiation of nivolumab, he had received two esophageal stents and an angiogenesis inhibitor. These are known risk factors for fistula formation. This is a rare case showing that nivolumab monotherapy might induce bronchoesophageal fistulae. Therefore, clinicians should be aware of the factors related to fistula formation when using ICIs.
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Affiliation(s)
- Akihiro Nishiyama
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroyuki Sakaguchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Naohiro Yanagimura
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Chiaki Suzuki
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Sakiko Otani
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Kaname Yamashita
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroko Ikeda
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa 920-8641, Ishikawa, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
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Marwah V, Katoch CDS, Kumar K, Pathak K, Bhattacharjee S, Jindamwar P. Bronchoscopic device closure of postoperative bronchopleural fistulae: Novel devices and innovative techniques. Lung India 2020; 37:107-113. [PMID: 32108593 PMCID: PMC7065536 DOI: 10.4103/lungindia.lungindia_179_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Bronchoscopic device closure plays a significant role in the nonsurgical management of bronchopleural fistulae (BPF). Herein, we describe our 10-year experience in the management of postoperative BPF using various device closure modalities. This is the largest series of bronchoscopic device closure of BPF being reported from India. Materials and Methods This was a retrospective analysis of data of patients who underwent bronchoscopic device closure with various techniques for the management of postoperative BPF. In total, 11 patients (six males and five females) with a mean age (±standard deviation) of 42.72 ± 14.40 years with BPFs were treated with various bronchoscopic interventions for BPF closure. We used various devices such as endobronchial coils, occluder devices, and covered tracheobronchial self-expandable stents for BPF closure depending on the size of air leaks. We describe the various devices used, technique, and outcome of bronchoscopic management of BPF. Results All our patients had developed BPFs postoperatively. Pulmonary tuberculosis was the most common etiology seen in nine of our patients. All the devices were placed using a fiberoptic bronchoscope, and all patients were followed up for a minimum duration of 6 months. We successfully localized and closed BPFs in nine (81.81%) of our patients. Conclusions Bronchoscopic device closure can be a successful strategy to manage postoperative BPF with minimal complications.
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Affiliation(s)
- Vikas Marwah
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - C D S Katoch
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - Kunal Kumar
- Department of Pulmonary, Critical Care and Sleep Medicine, Military Hospital (CTC), Pune, Maharashtra, India
| | - Kamal Pathak
- Department of Interventional Radiology, Excelcare Hospitals, Guwahati, Assam, India
| | | | - Prashant Jindamwar
- Department of Microbiology, Military Hospital (CTC), Pune, Maharashtra, India
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9
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Cusumano G, Alifano M, Lococo F. Endoscopic and surgical treatment for bronchopleural fistula after major lung resection: an enduring challenge. J Thorac Dis 2019; 11:S1351-S1356. [PMID: 31245131 DOI: 10.21037/jtd.2019.03.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giacomo Cusumano
- Unit of Thoracic Surgery, "Policlinico Vittorio Emanuele Hospital", Catania, Italy
| | - Marco Alifano
- Department of Thoracic surgery, Groupe Hospitalier Cochin Hôtel-Dieu, AP-HP, Université Paris Descartes, Paris
| | - Filippo Lococo
- Unit of Thoracic Surgery, Azienda Unica Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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10
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Oki M, Seki Y. A customized, covered metallic stent to repair a postoperative bronchopleural fistula: a promising endobronchial approach. J Thorac Dis 2019; 11:1088-1090. [PMID: 31179047 DOI: 10.21037/jtd.2019.02.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Masahide Oki
- Departement of Respiratory Medicine, Nagoya Medical Center, Nagoya, Japan
| | - Yukio Seki
- Departement of Thoracic Surgery, Nagoya Medical Center, Nagoya, Japan
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Harris K. Customized airway stenting for bronchopleural fistula after pulmonary resection by interventional technique: single-center study of 148 consecutive patients. J Thorac Dis 2019; 11:S1274-S1276. [PMID: 31245107 DOI: 10.21037/jtd.2019.05.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kassem Harris
- Department of Medicine, Division of Pulmonary Critical Care, Interventional Pulmonology Section. Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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12
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Lorut C, Giraud F, Lefebvre A. [Bronchoscopic treatment of bronchopleural fistula]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:359-362. [PMID: 30316652 DOI: 10.1016/j.pneumo.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Bronchopleural fistula is an uncommon complication occurring especially following lung resection (pneumonectomy) and associated with high morbidity and mortality rates. The treatment is surgical but some studies reported bronchoscopic treatment. Localization and size of the fistula may indicate different endoscopic procedures. This overview described the different endoscopic procedures and their benefits.
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Affiliation(s)
- C Lorut
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - F Giraud
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Lefebvre
- Service de pneumologie, hôpital Cochin, 27, boulevard du Faubourg-Saint-Jacques, 75014 Paris, France
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13
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de Lima A, Holden V, Gesthalter Y, Kent MS, Parikh M, Majid A, Chee A. Treatment of persistent bronchopleural fistula with a manually modified endobronchial stent: a case-report and brief literature review. J Thorac Dis 2018; 10:5960-5963. [PMID: 30505507 DOI: 10.21037/jtd.2018.08.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andres de Lima
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Van Holden
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yaron Gesthalter
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael S Kent
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mihir Parikh
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alex Chee
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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14
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An Innovative Solution for Prolonged Air Leaks: The Customized Endobronchial Silicone Blocker. J Bronchology Interv Pulmonol 2018; 25:111-117. [PMID: 29346253 DOI: 10.1097/lbr.0000000000000459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prolonged air leak (PAL) is a life-threatening condition that can present either as bronchopleural fistula, or alveolar-pleural fistula (APF). Although numerous bronchoscopic treatments are described, they are either expensive, not widely available in the developing world or have limited success. We describe our experience with a novel customized endobronchial silicone blocker (CESB) for PAL treatment. METHODS This is a retrospective study of PAL patients who underwent CESB placement. The air leak was localized using a balloon occlusion test. The CESB was uniquely designed by molding silicone stent pieces into a conical shape, deployed with rigid bronchoscopy into the appropriate segment, and reinforced with cyanoacrylate glue to prevent migration. In patients with APF, pleurodesis was performed after leak resolution to prevent recurrence. Following this, the CESB was removed after 6 weeks. RESULTS Forty-nine CESBs were placed in 31 patients (25 male individuals, 6 female individuals) with mean age of 49.7±19.7 years. The PALs included APF (n=16), bronchopleural fistula (n=14), and airway-mediastinal fistula (n=1). The average diameter of the CESB used was 7.9±2.9 mm. There was resolution of the PAL in 26 of 31 patients (84%). The CESB migrated in 5 patients with no adverse events. Pleurodesis was performed in 13 of 16 patients with APF, to prevent recurrence. No other significant complications were observed. CONCLUSIONS CESBs represent a safe, effective, and innovative approach in the management of PAL. They should be considered in patients who are not surgical candidates, fail surgery, or those who have a recurrence following surgery.
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Rethoracotomy for early complications: A marker for increased morbidity and mortality. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:441-449. [PMID: 32082776 DOI: 10.5606/tgkdc.dergisi.2018.15128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/16/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to examine the indications, timing and risk factors of rethoracotomy, analyze the postoperative results, and give suggestions to reduce the risks. Methods A total of 3,292 patients operated via thoracotomy between January 2006 and January 2017 were evaluated retrospectively. Demographic data, initial operative indications, surgical procedures, indications for rethoracotomy and preoperative risk factors, intraoperative findings and surgical methods, timing of rethoracotomy, morbidity and mortality results were analyzed of 66 patients (60 males, 6 females; mean age 59.4±12.4 years; range, 17 to 80 years) who were performed rethoracotomy before being discharged. Rethoracotomies performed within 72 hours after the first operation constituted the early and those performed after 72 hours constituted the late rethoracotomy group. Results Rethoracotomy was performed in average 4.7 days (range, 1 to 17 days). Early rethoracotomy was performed on 42 patients (1.3%) and 38 (90.4%) of these were due to hemorrhage. The most frequent indication for rethoracotomy was hemorrhage (n=41, 1.2%), followed by bronchopleural fistula (n=17, 0.5%). The other indications were chylothorax, lobe torsion, parenchymal air leak and collapse, and diaphragmatic laceration. Eight patients had rib fractures and all of these patients were over the age of 60. Eight patients who were performed rethoracotomy due to hemorrhage were using antiaggregant drugs. The postoperative morbidity and mortality rates were 33.3% (n=22) and 24.2% (n=16), respectively. Conclusion Rethoracotomy still has high morbidity and mortality rates. The main cause of rethoracotomy performed due to hemorrhage may be rib fractures or antiaggregant drugs. The most remarkable indications of rethoracotomy are hemorrhage and bronchopleural fistula.
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Flannery A, Daneshvar C, Dutau H, Breen D. The Art of Rigid Bronchoscopy and Airway Stenting. Clin Chest Med 2018; 39:149-167. [DOI: 10.1016/j.ccm.2017.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, Spaggiari L. Bronchopleural Fistula After Pneumonectomy: Risk Factors and Management, Focusing on Open-Window Thoracostomy. Semin Thorac Cardiovasc Surg 2017; 30:104-113. [PMID: 29109057 DOI: 10.1053/j.semtcvs.2017.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/11/2022]
Abstract
We evaluated principal risk factors and different therapeutic approaches for post-pneumonectomy bronchopleural fistula (BPF), focusing on open-window thoracostomy (OWT). We retrospectively reviewed all patients treated by pneumonectomy for lung cancer from 1999 to 2014; we evaluated preoperative, operative, and postoperative data; time between operation; and fistula formation, size, treatment, and predicting factors of BPF. Cumulative incidence curves for the development of BPF were drawn according to the Kaplan-Meier method. Differences between groups were assessed with the log rank test. Multivariable Cox proportional hazards regression analysis was used to assess the independent risk factors for BPF. P values <0.05 were considered significant. BPF occurred in 60 of 733 patients (8.2%). Bronchial suture with Stapler (EndoGia) (P = 0.02), right side (P = 0.003), and low preoperative albumin levels (< 3.5 g/dL) (P = 0.02) were independent predicting factors of fistula. Early BPF was treated by thoracotomic (12) or thoracoscopic (2) debridement of necrotic tissue and BPF surgical repair. Late BPF was treated by bronchoscopic application of fibrin glue (3) or endobronchial stent (1), chest tube and cavity irrigation by povidone-iodine (15). OWT was performed in 27 patients, followed by muscle flap interposition in 7 of these 27. The survival time of patients after the treatment of BPF was 29.0 months. The overall survival of patients treated by OWT was 50% at 2 years and 27 (8%) at 4 years. Correct management of BPF depends on several factors. In case of failure of different initial therapeutic approaches, we could consider OWT, followed by myoplasty.
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Affiliation(s)
- Antonio Mazzella
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Francesco Petrella
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of thoracic surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology/Oncology-DIPO, University of Milan, Milan, Italy.
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Abstract
Bronchopleural fistula (BPF) with prolonged air leak (PAL) is most often, though not always, a sequela of lung resection. When this complication occurs post-operatively, it is associated with substantial morbidity and mortality. Surgical closure of the defect is considered the definitive approach to controlling the source of the leak, but many patients with this condition are suboptimal operative candidates. Therefore there has been active interest for decades in the development of effective endoscopic management options. Successful use of numerous bronchoscopic techniques has been reported in the literature largely in the form of retrospective series and, at best, small prospective trials. In general, these modalities fall into one of two broad categories: implantation of a device or administration of a chemical agent. Closure rates are high in published reports, but the studies are limited by their small size and multiple sources of bias. The endoscopic procedure currently undergoing the most systematic investigation is the placement of endobronchial valves. The aim of this review is to present a concise discussion on the subject of PAL and summarize the described bronchoscopic approaches to its management.
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Affiliation(s)
- Sevak Keshishyan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Alberto E Revelo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, Valhalla, NY, USA
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Fiorelli A, Caterino U, Raucci A, Santini M. A conical self-expanding metallic stent for the management of critical complex tracheobronchial malignant stenosis. Interact Cardiovasc Thorac Surg 2017; 24:293-295. [PMID: 27815411 DOI: 10.1093/icvts/ivw349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/19/2016] [Indexed: 11/13/2022] Open
Abstract
Tracheobronchial malignant stenosis is a life-threatening and challenging condition. In inoperable patients, a stent is the mainstay treatment to ensure ventilation. Here, we report the use of a fully covered standard conical self-expandable metallic stent as an emergency treatment for complex tracheobronchial malignant stenosis.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
| | | | - Antonio Raucci
- Department of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Seconda Università degli Studi di Napoli, Naples, Italy
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Mazzella A, Pardolesi A, Maisonneuve P, Petrella F, Galetta D, Gasparri R, Spaggiari L. WITHDRAWN: Bronchopleural fistula after pneumonectomy: Risk factors and management, focusing on open window thoracostomy. J Thorac Cardiovasc Surg 2017:S0022-5223(17)31189-3. [PMID: 28697892 DOI: 10.1016/j.jtcvs.2017.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Antonio Mazzella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Roberto Gasparri
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology/Oncology, University of Milan, Milan, Italy
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Battistoni P, Caterino U, Batzella S, Dello Iacono R, Lucantoni G, Galluccio G. The Use of Polyvinyl Alcohol Sponge and Cyanoacrylate Glue in the Treatment of Large and Chronic Bronchopleural Fistulae following Lung Cancer Resection. Respiration 2017; 94:58-61. [PMID: 28538215 DOI: 10.1159/000477350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchopleural fistulae represent a relatively rare complication of pulmonary resection. For inoperable patients, several endoscopic procedures have been described. In the presence of large and chronic bronchopleural fistulae, persistent air leaks require a surgical therapy, while endoscopic airway stent represents a useful palliative treatment. OBJECTIVE We describe the successful closure of large and chronic bronchopleural fistulae using an expandable polyvinyl alcohol (PVA) sponge and cyanoacrylate glue. METHODS In all patients, a rigid bronchoscope was used to insert a small cylinder of PVA sponge within the fistula. After releasing the patch, cyanoacrylate glue was applied directly on the PVA sponge using a channel catheter. This methodology induces an expansion of the clot and the closure of the air leak. The long-term outcome of treatment was checked by flexible bronchoscopy once every month for 3 months and every 6 months until 5 years. RESULTS We performed endoscopic treatment in 7 consecutive patients with bronchopleural fistula ranging from 4 to 8 mm. In 6 of 7 patients, the bronchial stump was the site of the fistula. In 1 patient, the fistula was visualized on the right wall of the distal trachea. A temporary complete occlusion of the fistula was achieved in 7 of 7 patients and a definitive result in 5 of 7 patients. CONCLUSIONS The use of an expandable PVA sponge and cyanoacrylate glue is an available strategy for endobronchial closure of bronchopleural fistulae.
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Affiliation(s)
- Paolo Battistoni
- Thoracic Endoscopy Unit, San Camillo - Forlanini Hospital, Rome, Italy
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D'Andrilli A, Andreetti C, Menna C, Rendina EA. Successful endoscopic treatment of severe ischemic damage of the bronchus. J Thorac Cardiovasc Surg 2017; 154:e17-e19. [PMID: 28390763 DOI: 10.1016/j.jtcvs.2017.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/30/2016] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy; Lorillard Spencer Cenci Foundation, Rome, Italy
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Liberman M. Therapeutic interventional endoscopic bail-out in life-threatening surgical complications. J Thorac Cardiovasc Surg 2017; 154:e21. [PMID: 28359579 DOI: 10.1016/j.jtcvs.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Moishe Liberman
- Division of Thoracic Surgery, University of Montreal, Montreal, Quebec, Canada.
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Mao R, Ying PQ, Xie D, Dai CY, Zha JY, Chen T, Jiang GN, Fei K, Chen C. Conservative management of empyema-complicated post-lobectomy bronchopleural fistulas: experience of consecutive 13 cases in 9 years. J Thorac Dis 2016; 8:1577-86. [PMID: 27499946 DOI: 10.21037/jtd.2016.06.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after lung surgery. Tentative closure of the fistula and irrigation have been the conventional treatments, but are also surgically challenging and associated with a considerable failure rate. This study reports on a conservative practice of this difficult issue, in aim to examine its outcomes. METHOD All enrolled cases were handled consecutively from September 2006 to June 2015. The empyema was first properly drained till disseminated pneumonia controlled. After conducting lavage, tube drainage was gradually transited to postural drainage. During the follow-up, information on tube removal, fistula healing, and survival were recorded. RESULTS Thirteen cases were enrolled, including 9 rights and 4 lefts. The primary diseases were lung cancer [10], lung abscess [1], organizing pneumonia [1], and aspergillosis [1]. Early fistula (≤30 days postoperatively) occurred in 8 cases and late fistula (>30 days postoperatively) in 5 cases. Two patients underwent debridement to ascertain complete drainage. Chest tubes retained from 7 to 114 days (mean 40.54±30.49 days) before removal. At follow-up, we observed gradually narrowing-down of all residual cavities, and symptoms of fistula and empyema eventually disappeared in all patients. No complication or death occurred during the follow-up. CONCLUSIONS Conservative management by a combination of tube and postural drainage provides an effective and safe treatment for empyema-complicated post-lobectomy BPFs.
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Affiliation(s)
- Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Peng-Qing Ying
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chen-Yang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Jun-Yan Zha
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ge-Ning Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Ke Fei
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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26
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Klotz LV, Gesierich W, Schott-Hildebrand S, Hatz RA, Lindner M. Endobronchial closure of bronchopleural fistula using Amplatzer device. J Thorac Dis 2015; 7:1478-82. [PMID: 26380774 DOI: 10.3978/j.issn.2072-1439.2015.08.25] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 08/25/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Bronchopleural fistulas (BPF) are a dreaded complication after lobectomy and pneumonectomy and are associated with high morbidity and mortality. BPF are treated by a range of surgical and endoscopic techniques. Amplatzer devices (ADs), normally used for the closure of cardiac defects, may enable the minimally invasive occlusion of these defects. METHODS Three patients with BPF were treated with the bronchoscopic closure of BPF using AD. Under general anaesthesia, the fistula was located using bronchography and the self-expanding AD was placed under direct bronchoscopic and fluoroscopic guidance into the fistula. Bronchography was used to control the complete occlusion of the BPF. RESULTS Three male patients with a mean age of 63 years (range, 53-73 years) were successfully treated by AD. Two BPF occurred after lobectomy of the right lower lobe for lung cancer and one after right pneumonectomy for lung cancer. In all patients the bronchoscopic procedure was successful and symptoms of empyema and BPF showed no recurrence over a median follow-up of 22 months. CONCLUSIONS Endobronchial closure of BPF using AD represents a safe, effective and promising method for postoperative BPF.
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Affiliation(s)
- Laura V Klotz
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Wolfgang Gesierich
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sabine Schott-Hildebrand
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Rudolf A Hatz
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michael Lindner
- 1 Department of Thoracic Surgery, 2 Department of Pneumology, Center for Thoracic Surgery Munich, (Asklepios Medical Center Munich-Gauting/Ludwig-Maximilians-University Munich), Member of the German Center for Lung Research (DZL), Munich, Germany
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Musani AI, Dutau H. Management of alveolar-pleural fistula: a complex medical and surgical problem. Chest 2015; 147:590-592. [PMID: 25732439 DOI: 10.1378/chest.14-2202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ali I Musani
- Division of Pulmonary, Critical Care and Sleep Medicine, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France.
| | - Hervé Dutau
- National Jewish Health, Thoracic Endoscopy Unit, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
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Marchese R, Poidomani G, Paglino G, Crimi C, Lo Nigro C, Argano V. Fully covered self-expandable metal stent in tracheobronchial disorders: clinical experience. ACTA ACUST UNITED AC 2015; 89:49-56. [PMID: 25592654 DOI: 10.1159/000368614] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 09/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The third-generation fully covered self-expandable metallic stent (SEMS) has been developed to solve the problems of difficult removal and in-stent granuloma formation related to the uncovered or partially covered type. There are few written reports about the performance of this type of stents with early encouraging results. OBJECTIVES To report and analyse our experience with the Silmet® stent in the management of malignant and benign tracheobronchial disorders. METHODS We retrospectively reviewed medical records of patients who underwent fully covered SEMS Silmet placement at the Interventional Pulmonology Unit, La Maddalena Cancer Center, Palermo, Italy, between May 2010 and August 2013. RESULTS Stents were placed in 52 patients with malignant (n = 49) and benign airway obstruction (n = 2) and broncho-oesophageal fistula (n = 1). SEMSs were inserted into the trachea (n = 19), the main bronchi (n = 21) and the peripheral bronchi (n = 31). Besides 1 procedural dislocation, the deployment was successful in all patients with an immediate significant improvement of symptoms (Barthel Index p < 0.001; Medical Research Council score p < 0.001). A radiographic improvement was detected in 48% of patients. The mean follow-up duration was 119 ± 120 days (range 22-549 days). Complications observed were: migration (7.6%), tumour overgrowth (15%), infections (5.7%), granulation tissue formation (3.8%) and mucus plug (3.8%). CONCLUSIONS The Silmet stent is effective, safe and simple to implant and remove. We suggest its use in cases of tight stenoses, in the treatment of small- to medium-caliber airways or in cases of tortuous airways.
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Affiliation(s)
- Roberto Marchese
- Interventional Pulmonology Unit, La Maddalena Cancer Center, Palermo, Italy
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Dutau H, Musani AI, Plojoux J, Laroumagne S, Astoul P. The use of self-expandable metallic stents in the airways in the adult population. Expert Rev Respir Med 2014; 8:179-90. [PMID: 24450436 DOI: 10.1586/17476348.2014.880055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.
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Affiliation(s)
- Herve Dutau
- North University Hospital, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, 13015 France
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Fruchter O, El Raouf BA, Abdel-Rahman N, Saute M, Bruckheimer E, Kramer MR. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up. ACTA ACUST UNITED AC 2014; 87:227-33. [PMID: 24434610 DOI: 10.1159/000357074] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/27/2013] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Oren Fruchter
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dabar G, Daher M, Harmouche C. [Bronchopericardial fistula treatment by a metallic stent]. Rev Mal Respir 2013; 30:429-32. [PMID: 23746818 DOI: 10.1016/j.rmr.2012.10.628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 10/16/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Bronchopericardial fistula is a rare condition leading to pneumopericardium. This medical condition is often related to neoplastic disease, or a complication of surgical interventions. The treatment approach depends on both the etiology and the clinical presentation. In stable patients, pericardial drain insertion and/or surgical resection of the fistula are considered options for persistent cases. We present the case of a bronchopericardial fistula treated by placement of an endobronchial stent. CASE PRESENTATION A 64-year-old man operated on for lung cancer had a recurrence treated with radiation and chemotherapy. A pneumopericadium was discovered when he presented with a new onset of atrial fibrillation. Bronchoscopy revealed a fistula tract. Pericardial drainage was persistent and did not improve the clinical situation. The poor health status of the patient contraindicated surgery and an alternative therapeutic approach with endobronchial stent placement was undertaken. The fistula sealed immediately, the pericardial drain could be removed removed and the patient was able to be discharged from hospital. CONCLUSION Endobronchial stenting should be considered as a potential treatment option in patients with pneumopericardium secondary to bronchopericadial fistula, particularly where a non-surgical is required.
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Affiliation(s)
- G Dabar
- Service de pneumologie et réanimation médicale, Hôtel-Dieu de France, BP 16-6830, boulevard Alfred-Naccache, Achrafieh, Beyrouth, Liban.
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Bylicki O, Peloni JM, Loheas D, Turc J, Petitjean F, Puidupin M, Mulsant P, Dot JM. [Endoscopic management of broncho-pleural fistula in a patient with acute respiratory distress syndrome after pneumonectomy]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:269-272. [PMID: 22763335 DOI: 10.1016/j.pneumo.2012.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 02/13/2012] [Accepted: 03/18/2012] [Indexed: 06/01/2023]
Abstract
We report the management of endobronchial a patient admitted to the ICU for respiratory distress in the consequences of an surgical recovery of his left pneumonectomy complicated by bronchopleural fistula as part of a bronchial carcinoma non-small cell type adenocarcinoma. Endobronchial treatment by gluing of the fistula may be an alternative to surgery. We discuss its indication in the treatment of bronchial fistula.
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Affiliation(s)
- O Bylicki
- Service de pneumologie, hôpital d'instruction des armées Desgenettes, 106 boulevard Pinel, Lyon, France.
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Fruchter O, Bruckheimer E, Raviv Y, Rosengarten D, Saute M, Kramer MR. Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug. Eur J Cardiothorac Surg 2012; 41:46-9. [PMID: 21600781 DOI: 10.1016/j.ejcts.2011.02.080] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Bronchopulmonary fistula (BPF) is a severe complication following lobectomy or pneumonectomy and is associated with a high rate of morbidity and mortality. We have developed a novel minimally invasive method of central BPF closure using Amplatzer vascular plug (AVP) device that was originally designed for the transcatheter closure of vascular structures in patients with small BPF. METHODS Patients with BPFs were treated under conscious sedation by bronchoscopic closure of BPFs using AVP. After locating the fistula using bronchography, the self-expanding nitinol made AVP occluder to be delivered under direct bronchoscopic guidance over a loader wire into the fistula followed by bronchography to assure correct device positioning and sealing of the BPF. RESULTS Six AVPs were placed in five patients, four males and one female, with a mean age of 62.3 years (range: 51-82 years). The underlying disorders and etiologies for BPF development were lobectomy (two patients), pneumonectomy for lung cancer (one patient), lobectomy due to necrotizing pneumonia (one patient), and post-tracheostomy tracheo-pleural fistula (one patient). In all the patients, the bronchoscopic procedure was successful and symptoms related to BPF disappeared following closure by the AVP. The results were maintained over a median follow-up of 9 months (range: 5-34 months). CONCLUSIONS Endobronchial closure using the AVP is a safe and effective method for treatment of small postoperative BPF. The ease of their implantation by bronchoscopy under conscious sedation adds this novel technique to the armatorium of minimally invasive modalities for the treatment of small BPF.
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Affiliation(s)
- Oren Fruchter
- The Pulmonary Institute, Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tiqwa, Israel.
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Nosotti M, De Simone M, Cioffi U. eComment. post-pneumonectomy bronchopleural fistula: covered metallic stent or Amplatzer occluder? Interact Cardiovasc Thorac Surg 2012; 14:423; discussion 424. [PMID: 22438411 DOI: 10.1093/icvts/ivs062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Andreetti C, D'Andrilli A, Ibrahim M, Ciccone AM, Maurizi G, Mattia A, Venuta F, Rendina EA. Effective treatment of post-pneumonectomy bronchopleural fistula by conical fully covered self-expandable stent. Interact Cardiovasc Thorac Surg 2012; 14:420-3. [PMID: 22268070 DOI: 10.1093/icvts/ivr077] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to assess the feasibility, efficacy and safety of the use of a conical self-expandable stent for the treatment of post-pneumonectomy bronchopleural fistula (PPBPF). Between April 2008 and November 2010, six patients underwent treatment for the PPBPF by the introduction of a tracheobronchial conical fully covered self-expandable nitinol stent with the aim of excluding the bronchial dehiscence from the airflow. We secured the prosthesis to the tracheal mucosa with titanium helical fasteners tacks. Five patients presented with a bronchial fistula larger than 5 mm following right (4) or left (1) pneumonectomy. One patient had an anastomotic dehiscence after right tracheal sleeve pneumonectomy. A chest tube showed the absence of empyema in all cases. Immediate resolution of the bronchial air leak was obtained in all the patients. Permanent closure of the bronchial dehiscence without recurrence was achieved in all the patients at a mean follow-up time of 13 months (range 3-32). The bronchial stent was successfully removed in all patients without sequelae 71-123 days after its implantation. The use of the conical self-expandable Silmet(®) stent has proved to be an effective, safe and fast method to treat even large PPBPFs.
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Affiliation(s)
- Claudio Andreetti
- Department of Thoracic Surgery, University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
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