[Closure of bronchial fistulas using amplatzer vascular plugs]

Bronchial fistulas occurring either spontaneously in the course of malignant diseases of the chest or following pulmonary resections (lobectomy, pneumonectomy) are rare, but feared complications associated with high morbidity and mortality. In many cases a surgical approach to fistula closure is not possible. Numerous endoscopic procedures for fistula closure have been reported, mostly in the form of isolated case reports with until now no satisfying results. No guidelines or consensus have been established as yet. Since 2006 several cases of successful fistula closure by using Amplatzer Septal Occluders have been reported. Between June and October 2010 five patients with oesophagobronchial or bronchopleural fistulas were successfully treated in our hospitals, using Amplatzer Vascular Plugs II® and 4® (AGA Medical) for fistula closure. These devices were originally developed for transcatheter embolisation procedures in angiology. Three of our patients suffered from bronchial fistulas after lobectomy or pneumonectomy with consecutive empyemas, the other two of bronchooesophageal fistulas caused by carcinomas of the oesophagus.