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Zhang J, Hu H, Xu L, Xu S, Zhu J, Wu F, Chen E. Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas. BMC Pulm Med 2021; 21:137. [PMID: 33902515 PMCID: PMC8077945 DOI: 10.1186/s12890-021-01493-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). The aim of the present report was to explore the reliability and advantages of the SFM in AD implantation. Methods We improved the existing implantation methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67 ± 6.19 years [mean ± SD]) had BPF blocking and underwent the SFM in AD implantation. Results AD implantation was successfully performed in all 6 patients with the SFM, 4 persons had a successful closure of the fistula, one person died after few days and one person did not have a successful closure of the fistula. The average duration of operation was 16.17 min (16.17 ± 4.67 min [mean ± SD]). No patients died due to operation complications or BPF recurrence. The average follow-up time was 13.2 months (range 10–17 months). Conclusion We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF blocking, and could contribute to significantly improved symptoms of patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01493-8.
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Affiliation(s)
- Jisong Zhang
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Huihui Hu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Li Xu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Shan Xu
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China
| | - Jihong Zhu
- Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fengjie Wu
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jiaxing, Jiaxing, Zhejiang Province, China
| | - Enguo Chen
- Department of Pulmonary and Critical Care Medicine, Sir Run Run Shaw Hospital of Zhejiang University, No. 3 East Qingchun Road, Jianggan District, Hangzhou, 310016, Zhejiang Province, China.
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Bronchopleural Fistula Closure With Amplatzer Device: Our Case and Reviewing a Decade of Experience. J Bronchology Interv Pulmonol 2021; 27:e41-e45. [PMID: 32569079 DOI: 10.1097/lbr.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Domingues CM, Matos V, Ferreira A, Jorge E, Bernardo J, Gonçalves L. Closure of bronchopleural fistula by a septal occluder device: a case for close collaboration between heart and lung specialists. BMJ Case Rep 2019; 12:12/7/e229575. [PMID: 31331927 DOI: 10.1136/bcr-2019-229575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 66-year-old woman who underwent right inferior lobectomy for pulmonary carcinoma and developed persistent bronchopleural fistula (BPF) that was not amenable to surgical intervention (two surgical failures). The patient presented with a persistent cough and dyspnoea, which was treated with a hybrid procedure using fluoroscopy and bronchoscopy. A 7 mm Amplatzer septal occluder device (ASOD) was successfully inserted into the BPF. Two weeks after the procedure, a small fistula developed, which was treated by endoscopically guided biologic glue embolisation. At 2-month, 6-month and 12-month follow-up visits, clinical examinations and endoscopic imaging confirmed the complete occlusion of the BPF. Obvious migration of the ASOD was not apparent, and the patient has remained asymptomatic. The success of an endoscopic BPF closure with the use of hybrid techniques was achieved because of a collaborative effort by a multidisciplinary team.
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Affiliation(s)
| | - Vitor Matos
- Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - António Ferreira
- Pneumology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - Elisabete Jorge
- Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Pneumology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - João Bernardo
- Cardiothoracic Surgery, Centro Hospitalar e Universitáriode Coimbra EPE, Coimbra, Portugal
| | - Lino Gonçalves
- Cardiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Tsilimigras DI, Antonopoulou A, Ntanasis-Stathopoulos I, Patrini D, Papagiannopoulos K, Lawrence D, Panagiotopoulos N. The role of BioGlue in thoracic surgery: a systematic review. J Thorac Dis 2017; 9:568-576. [PMID: 28449464 DOI: 10.21037/jtd.2017.02.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND BioGlue is a commonly used sealant in thoracic surgery. Prolonged air leak and presence of bronchopleural fistulae (BPF) are often encountered in clinical practice. We therefore, investigated the role and the efficacy of BioGlue in these scenarios. METHODS A systematic review was conducted by searching Medline [1966-2016] and Cochrane Central Register of Controlled Trials (CENTRAL) [1999-2016] along with reference lists of the included studies. Included studies reported on thoracic surgery operations and use of BioGlue in thoracic surgical procedures, whereas excluded studies met at least one of the following criteria: non-English language studies, non-human population, studies on surgical specialties other than Thoracic surgery, reviews and meta-analyses and sealants other than BioGlue. RESULTS Twelve studies with a total number of 194 patients were included. Amongst them, 178 were treated for alveolar air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was utilized at the time of initial operation in 172 (96.7%) patients for AAL, while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for lymphatic leak. In terms of AAL, only 2 out of 4 studies showed statistically significant reduction in duration of air leak, duration of intercostal drainage and length of stay (LOS) when BioGlue was applied. No complications were encountered after using BioGlue in sealing BPF, apart from the re-application of BioGlue in 3 cases. CONCLUSIONS Although BioGlue has been shown to be efficient in treating AAL, it should be used with caution against BPF, despite encouraging preliminary results. Potential adverse effects must always be taken into consideration. Future randomized controlled trials are warranted in an attempt to establish its benefit in current clinical practice.
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Affiliation(s)
- Diamantis I Tsilimigras
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aspasia Antonopoulou
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, University of Patras, Patras, Greece
| | | | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
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Yamamoto S, Endo S, Minegishi K, Shibano T, Nakano T, Tetsuka K. Polyglycolic acid mesh occlusion for postoperative bronchopleural fistula. Asian Cardiovasc Thorac Ann 2015; 23:931-6. [PMID: 26187458 DOI: 10.1177/0218492315594071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative bronchopleural fistula is one of the most life-threatening complications after anatomical pulmonary resection. Bronchopleural fistula may cause empyema and aspiration pneumonia with subsequent acute respiratory distress syndrome. Surgical interventions for bronchopleural fistula can prolong hospitalization and impair postoperative quality of life. Postoperative care requires minimally invasive endoscopic occlusion. METHODS We retrospectively reviewed the records of 7 patients who developed bronchopleural fistula among 689 patients who underwent segmentectomy or lobectomy without sleeve resection for lung cancer in Jichi Medical University from 2009 to 2013. Bronchopleural fistula occurred in the right lower bronchial stump in 3 patients, in the superior segmental bronchus of the right lower lobe in 2, in the superior segmental bronchus of the left lower lobe in one, and in the right intermediate bronchus in one. Flexible bronchoscopy was used to occlude 3-mm fistulas with polyglycolic acid mesh in 2 patients. Larger fistulas in 5 patients were occluded with polyglycolic acid mesh plus fibrin glue to secure the mesh. The median procedure was 37 min. Procedures were considered complete upon resolution of air leakage from the chest drainage system. RESULTS Bronchoscopic interventions for bronchopleural fistula were repeated an average of 2 times. No procedure-related complications or death occurred. Bronchoscopic interventions were successful in all patients. CONCLUSIONS Bronchoscopic occlusion with polyglycolic acid mesh with or without fibrin glue is easy and feasible as the first step in postoperative management of bronchopleural fistula.
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Affiliation(s)
- Shinichi Yamamoto
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shunsuke Endo
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kentaro Minegishi
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoki Shibano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kenji Tetsuka
- Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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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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