title: Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug.
abstract: OBJECTIVE
  Bronchopulmonary fistula (BPF) is a severe complication following lobectomy or pneumonectomy and is associated with a high rate of morbidity and mortality. We have developed a novel minimally invasive method of central BPF closure using Amplatzer vascular plug (AVP) device that was originally designed for the transcatheter closure of vascular structures in patients with small BPF.
  
  
  METHODS
  Patients with BPFs were treated under conscious sedation by bronchoscopic closure of BPFs using AVP. After locating the fistula using bronchography, the self-expanding nitinol made AVP occluder to be delivered under direct bronchoscopic guidance over a loader wire into the fistula followed by bronchography to assure correct device positioning and sealing of the BPF.
  
  
  RESULTS
  Six AVPs were placed in five patients, four males and one female, with a mean age of 62.3 years (range: 51-82 years). The underlying disorders and etiologies for BPF development were lobectomy (two patients), pneumonectomy for lung cancer (one patient), lobectomy due to necrotizing pneumonia (one patient), and post-tracheostomy tracheo-pleural fistula (one patient). In all the patients, the bronchoscopic procedure was successful and symptoms related to BPF disappeared following closure by the AVP. The results were maintained over a median follow-up of 9 months (range: 5-34 months).
  
  
  CONCLUSIONS
  Endobronchial closure using the AVP is a safe and effective method for treatment of small postoperative BPF. The ease of their implantation by bronchoscopy under conscious sedation adds this novel technique to the armatorium of minimally invasive modalities for the treatment of small BPF.
authors: The Pulmonary Institute, Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tiqwa, Israel. orenfr@clalit.org.il
authors: Oren
authors: O
authors: Fruchter
authors: Elchanan
authors: E
authors: Bruckheimer
authors: Yael
authors: Y
authors: Raviv
authors: Dror
authors: D
authors: Rosengarten
authors: Milton
authors: M
authors: Saute
authors: Mordechai R
authors: MR
authors: Kramer
references: Ann Thorac Surg. 2009 Nov;88(5):1691-2
references: 19853144
references: Cardiovasc Intervent Radiol. 2008 Jul;31 Suppl 2:S84-7
references: 17468902
references: Chest. 1986 Sep;90(3):321-3
references: 3743142
references: Chest. 2008 Jun;133(6):1481-1484
references: 18574292
references: Intensive Care Med. 2010 Apr;36(4):721-2
references: 20107764
references: Diagn Interv Radiol. 2008 Mar;14(1):35-9
references: 18306144
references: Chest. 2006 Feb;129(2):479-481
references: 16478869
references: Ann Thorac Cardiovasc Surg. 2001 Dec;7(6):330-6
references: 11888471
references: Ann Thorac Surg. 2007 Apr;83(4):1519-21
references: 17383371
references: Chest. 1990 May;97(5):1235-8
references: 2331919
references: Chest. 2005 Dec;128(6):3955-65
references: 16354867
references: Chest. 2011 Mar;139(3):682-687
references: 21362655
references: Eur J Cardiothorac Surg. 2000 Nov;18(5):519-23
references: 11053810
references: Gen Thorac Cardiovasc Surg. 2009 Dec;57(12):675-7
references: 20013106
references: Eur Radiol. 2010 Nov;20(11):2663-70
references: 20574633
references: Ann Thorac Surg. 2010 Jan;89(1):293-6
references: 20103263
references: J Thorac Cardiovasc Surg. 2006 Jul;132(1):99-104
references: 16798308
references: Semin Thorac Cardiovasc Surg. 2001 Jan;13(1):3-7
references: 11309718
references: Eur J Cardiothorac Surg. 2011 Feb;39(2):185-9
references: 20591685