Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas

A novel method for the bronchial occlusion of prolonged air leakage using customized endobronchial plugs

Background

The management of prolonged air leakage (PAL) is a significant clinical challenge, particularly for patients who are unfit for surgical treatment. The use of endoscopic interventions with occlusive devices has been reported previously; however, local availability and cost may represent potential hurdles, especially in developing countries. In this study, we presented a conical endobronchial plug of our design and evaluated the efficacy of making use of that in the treatment of PAL as a novel method.

Methods

This retrospective study included a total of 23 patients with PAL who were not suitable for surgery and underwent bronchial occlusion using customized plugs. The responsible bronchi were identified by the balloon occlusion test or by end-tidal carbon dioxide detection. In each case, the plug was grasped at the knot of the tip with forceps and then inserted into the target bronchus with a flexible bronchoscope.

Results

Of the 23 patients with intractable pneumothorax, 1 to 3 plugs (median =1) were successfully inserted into the affected bronchi of each patient for bronchial occlusion. Air leakage showed complete cessation in 13 patients (56.5%) and reduction in seven patients (30.4%). A total of 20 patients (87.0%) experienced successful removal of the drainage tube following plug occlusion or presented with additional pleurodesis. Complications included expectoration of the plug (n=1) and fever (n=1); no other severe complications were observed.

Conclusions

Bronchial occlusion using customized endobronchial plugs appears to be an effective and simple option for the management of PAL in patients who are not suitable for surgery, especially in developing countries, as the customized plug is a cost-effective alternative.

Bronchopleural Fistula Management With an Amplatzer Duct Occluder: A Comprehensive Case Report and Literature Review

Bronchial stump insufficiency (BSI), also reported as bronchopleural fistula, following pneumonectomy is a rare but potentially devastating complication that can result in substantial morbidity and mortality. Despite advances in thoracic surgical techniques and perioperative care, bronchial stump dehiscence remains a challenging clinical scenario, especially when associated with severe infections and compromised patient conditions. Traditional surgical re-intervention to address this complication may carry significant risks and might be contraindicated in certain patients. As a result, innovative interventions are necessary to address these challenging cases effectively. In this report, we present an interventional endoscopic technique using an Amplatzer Duct occluder for the successful management of BSI in a 55-year-old male patient with a complex medical history.

Covered SEMS failed to cure airway fistula closed by an amplatzer device

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.