Precision Closure of Postsurgical Bronchopleural Fistulas Using Vascular Plugs

Area of Science:

• Thoracic Surgery
• Interventional Pulmonology
• Medical Devices

Background:

• Bronchopleural fistula (BPF) is a serious postoperative complication of thoracic surgery, associated with significant morbidity and mortality.
• Current surgical treatments for BPF are invasive, necessitating the exploration of less invasive alternatives.
• The Amplatzer vascular plug (AVP), a device primarily used for vascular embolization, presents a potential solution for BPF closure.

Purpose of the Study:

• To evaluate the efficacy and safety of using Amplatzer vascular plugs (AVPs) for bronchoscopic closure of bronchopleural fistulas (BPFs).

Main Methods:

• The study involved 3 male patients who underwent bronchoscopic closure of BPFs using AVPs II and IV after lobectomy or pneumonectomy.
• AVP II was utilized for fistulas larger than 6 mm, while AVP IV was used for fistulas smaller than 6 mm.
• Procedures were conducted under general anesthesia in a hybrid operating room, employing flexible bronchoscopy with fluoroscopic guidance.

Main Results:

• Successful closure of bronchopleural fistulas was achieved in all three patients.
• No complications were reported during or after the procedures.
• Follow-up over 11 months (range 3-22 months) demonstrated stable device placement, clinical improvement, and no 90-day mortality.

Conclusions:

• Amplatzer vascular plug (AVP) closure represents a safe, effective, and minimally invasive method for managing bronchopleural fistulas (BPFs).
• This technique is a promising first-line treatment option for patients with BPF who are not candidates for conventional surgery.
• Further research is warranted to confirm these preliminary findings and establish AVP closure as a standard treatment modality.