B46-01 Bridging the Gap: Amplatzer Occluder as a Life Saving Alternative in Bronchopleural Fistula Management
Abstract
Bronchopleural fistulas (BPF) are abnormal communications between the bronchial tree and pleura, resulting in persistent air leaks associated with high morbidity and mortality. They are most commonly a complication of lung resection, with incidence up to 20% post-pneumonectomy and 0.5% post-lobectomy. One-way endobronchial valves (EBV) provide a minimally invasive method for managing postoperative air leaks, serving as a bridge to definitive surgical management.
We report the case of a 39-year-old healthy male, who presented with hypoxia secondary to Streptococcus pneumoniae pneumonia requiring intubation. His course progressed to ARDS, complicated by empyema, right middle lobe necrosis and trapped lung necessitating decortication and right lower lobectomy. After extubation, he developed a large right hydropneumothorax with worsening hypoxia requiring re-intubation. Bronchoscopy revealed right lower lobe stump dehiscence with continuous air leak and persistent hydropneumothorax. The defect was too large for EBV placement, and he was not a surgical candidate due to intolerance of single-lung ventilation. A 10-mm Amplatzer device was placed, resulting in reduced air leak, with adjunctive Surgicel application when leak recurred. The device remained in place during tracheostomy and rehabilitation, allowing stabilization and definitive surgical repair with omental flap placement.
Large BPFs following thoracic surgery often necessitate closure with muscle flap reinforcement.…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 72 participants or records.
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