Case report: Endobronchial closure of postoperative bronchopleural fistula with embolization coil: a sandwich-like approach

作者全名：Bai, Yang; Chi, Jing; Wang, Hansheng; Li, Yishi; Guo, Shuliang

作者地址：[Bai, Yang; Chi, Jing; Li, Yishi; Guo, Shuliang] Chongqing Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Chongqing, Peoples R China; [Wang, Hansheng] Chongqing Med Univ, Affiliated Hosp 1, Dept Radiol, Chongqing, Peoples R China

通信作者：Li, YS; Guo, SL (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Resp & Crit Care Med, Chongqing, Peoples R China.

来源：FRONTIERS IN MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001230928100001

JCR分区：Q1

影响因子：3.1

年份：2024

卷号：11

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：bronchopleural fistula; Embolization Coil; bronchoscopic treatment; case series; interventional pulmonary

摘要：Background Embolization Coil has been reported to effectively treat postoperative bronchopleural fistula (BPF). Little detailed information was available on computer tomography (CT) imaging features of postoperative BPF and treating procedures with pushable Embolization Coil.Objective We aimed to specify the imaging characteristics of postoperative BPFs and present our experience treating them with the pushable Embolization Coil.Methods Six consecutive patients (four males and two females aged 29-56 years) diagnosed with postoperative BPF receiving bronchoscopic treatment with the pushable Nester (R) Embolization Coil (Cook Medical, Bloomington, Indiana) were included in this single-center, retrospective study. Multiplanar reconstruction of multidetector CT scans was reviewed for the presence, location, size, and radiological complications of each BPF, including air collection, pneumothorax, bronchiectasis, and chest tube. Using standardized data abstraction forms, demographic traits and clinical outcomes were extracted from the medical files of these patients.Results The underlying diseases for lung resection surgery were pulmonary tuberculosis (n = 3), lung adenocarcinoma (n = 2), and pulmonary aspergillosis (n = 1). All patients had air or air-fluid collection with chest tubes on radiological findings. Multiplanar reconstruction identified the presence of postoperative BPF in all patients. Five fistulas were central, located proximal to the main or lobar bronchus, while one was peripheral, distant from the lobar bronchus. Fistula sizes ranged from 0.8 to 5.8 mm. Subsequent bronchoscopy and occlusion testing confirmed fistula openings in the bronchial stump: right main bronchus (n = 1), right upper lobe (n = 2), and left upper lobe (n = 3). The angioplasty catheter-based procedure allows precise fistula occlusion "like a sandwich" with the pushable Embolization Coil. Five patients with BPF sizes ranging from 0.8 to 1.5 mm were successfully treated with a pushable Embolization Coil, except for one with a BPF size of 5.8 mm. No adverse events or complications were observed throughout follow-up, ranging from 29 to 1,307 days.Conclusion The pushable Nester (R) Embolization Coil seems a minimally invasive, cost-effective, and relatively easy-to-perform bronchoscopic treatment for postoperative BPF with a size less than 2 mm. Further studies are required to ensure the use of pushable Embolization Coil in treating postoperative BPF.

基金机构：Chongqing Medical University10.13039/501100004374

基金资助正文：We thank Tairong Tan, Meiling Xiao, Xia Zhang, Xingxing Jin, and Yang Xiao for their sincere and professional support of our work.