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Chest Aug 2017Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair... (Review)
Review
Alveolar-pleural fistulas causing persistent air leaks (PALs) are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit it is a solution with limited success. In patients who have recently undergone thoracic surgery or in whom surgery would be contraindicated based on the severity of illness, there has been a lack of treatment options. This review describes a brief history of treatment guidelines for PALs. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript describes these treatment options in detail, including postprocedural adverse events. Further research, including randomized controlled trials with comparison of these options, are needed, as is long-term follow-up for these interventions.
Topics: Air; Chest Tubes; Chronic Disease; Female; Humans; Lung Diseases; Male; Pleural Diseases; Pleurodesis; Pneumothorax; Practice Guidelines as Topic; Respiratory Tract Fistula; Risk Factors; Sex Factors
PubMed: 28267436
DOI: 10.1016/j.chest.2017.02.020 -
Therapeutic Advances in Respiratory... 2023Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are... (Review)
Review
Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are typically the main contributors to patient mortality because of the improper contact between the bronchial and pleural cavity. Therefore, bronchopleural fistulas need immediate treatment, which requires the accurate location and timely closure of the fistula. Currently, bronchoscopic interventions, because of their flexibility and versatility, are reliable alternative therapies in patients for whom surgical intervention is unsuitable. Possible interventions include bronchoscopic placement of blocking agents, atrial septal defect (ASD)/ventricular septal defect (VSD) occluders, airway stents, endobronchial valves (EBVs) and endobronchial Watanabe spigots (EWSs). Recent developments in mesenchymal stem cells (MSCs) transplantation technology and three-dimensional (3D) printed stents have also contributed to the treatment of bronchopleural fistula, but more research is needed to investigate the long-term benefits. This review focuses on the effectiveness of various bronchoscopic measures for the treatment of bronchopleural fistula and the directions for future development.
Topics: Humans; Bronchoscopy; Postoperative Complications; Pleural Diseases; Bronchial Fistula; Pneumonia; Pneumonectomy
PubMed: 37067054
DOI: 10.1177/17534666231164541 -
Korean Journal of Radiology Feb 2022Pulmonary arteriovenous malformation (AVM) is a congenital vascular disease in which interventional radiologists can play both diagnostic and therapeutic roles in... (Review)
Review
Pulmonary arteriovenous malformation (AVM) is a congenital vascular disease in which interventional radiologists can play both diagnostic and therapeutic roles in patient management. The diagnosis of pulmonary AVM is simple and can usually be made based on CT images. Endovascular treatment, that is, selective embolization of the pulmonary artery feeding the nidus of the pulmonary AVM, and/or selectively either the nidus or draining vein, has become a first-line treatment with advances in interventional devices. However, some vascular diseases can simulate pulmonary AVMs on CT and pulmonary angiography. This subset can confuse interventional radiologists and referring physicians. Vascular mimickers of pulmonary AVM have not been widely known and described in detail in the literature, although some of these require surgical correction, while others require regular follow-up. This article reviews the clinical and radiologic features of pulmonary AVMs and their mimickers.
Topics: Arteriovenous Fistula; Embolization, Therapeutic; Humans; Intracranial Arteriovenous Malformations; Pulmonary Artery; Pulmonary Veins
PubMed: 35029077
DOI: 10.3348/kjr.2021.0417 -
Journal of Vascular Surgery. Venous and... Mar 2024
Topics: Humans; Arteriovenous Fistula; Pulmonary Veins; Pulmonary Artery
PubMed: 37972756
DOI: 10.1016/j.jvsv.2023.101717 -
Respiratory Medicine Apr 2018A persistent air leak (PAL) can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). Complications from PAL lead to an increase in... (Comparative Study)
Comparative Study Review
A persistent air leak (PAL) can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). Complications from PAL lead to an increase in morbidity and mortality, prolonged hospital stay, and higher resource utilization. Pulmonary physicians and thoracic surgeons are often tasked with the difficult and often times frustrating diagnosis and management of PALs. While most patients will improve with chest tube thoracostomy, many will fail requiring alternative bronchoscopic or surgical strategies. Herein, we review the bronchoscopic and surgical diagnostic and treatment options for PAL as it pertains to the field of interventional pulmonology and thoracic surgery.
Topics: Bronchial Fistula; Bronchoscopy; Chest Tubes; Fistula; Humans; Length of Stay; Pleural Diseases; Pleurodesis; Randomized Controlled Trials as Topic; Septal Occluder Device; Thoracostomy
PubMed: 29605207
DOI: 10.1016/j.rmed.2018.03.017 -
Heart & Lung : the Journal of Critical... 2020Aorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce. (Review)
Review
BACKGROUND
Aorto-cardiac fistulae are a rare but increasingly reported entity, and data are scarce.
METHOD
The authors performed a systematic review of ACFs to characterize the underlying etiology, clinical presentation, and compare outcomes of treatment strategies.
RESULTS
3,733 publications were identified in the search. Of those, 292 studies including 300 patients were included. Etiology of ACFs was 38% iatrogenic, 25% infectious, 14% traumatic, and 15% due to other causes. Most patients (74%) presented with heart failure. Common locations were aortic-right atrium (37%), and aortic-pulmonary artery (25%). The majority of patients (71%) were treated surgically, while 13% were treated percutaneously, and 16% were treated conservatively. Patients who were managed conservatively had a higher mortality than those treated with invasive closure (53% vs. 12% vs. 3%, p = <0.00001).
CONCLUSIONS
This systematic review sheds light on this highly morbid condition. Once recognized, fistula closure appears to be superior to conservative management.
Topics: Aortic Diseases; Fistula; Heart Atria; Humans; Pulmonary Artery; Vascular Fistula
PubMed: 31735456
DOI: 10.1016/j.hrtlng.2019.11.002 -
Thoracic Cancer May 2022The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success.
BACKGROUND
The purpose of this study was to investigate the results of postoperative bronchopleural fistula repair and to identify adverse factors for its success.
METHODS
We retrospectively reviewed the surgical results of 39 patients who underwent surgical repair for postoperative bronchopleural fistula between January 2010 and June 2020. Success of bronchopleural fistula repair was defined as the visual closure of the bronchopleural fistula with the absence of an air leak, a recurrence of bronchopleural fistula and infection in the thoracic cavity.
RESULTS
Twenty-five (64.1%) bronchopleural fistulas occurred after pulmonary resection and 14 (35.9%) after lung transplantation. Bronchopleural fistula was diagnosed 19 days (median) and repaired 28 days (median) after the initial operation by primary closure in 27 (69.2%) patients, and by additional resection in 12 (30.8%) patients. The overall success rate was 59% (23/39) and the overall mortality was 56.4% (22/39). Multivariable analysis revealed that the patients who were supported by mechanical ventilation at the time of repair had significantly lower success rates than those without (15.4%, 2/13 vs. 80.8%, 21/26, respectively, p < 0.001). The omental flap group tended to have a better success rate than the muscle flap group (p = 0.07).
CONCLUSIONS
There was a high overall mortality rate after bronchopleural fistula repair and a low success rate. Mechanical ventilation at the time of bronchopleural fistula repair was significantly related to the failure of bronchopleural fistula repair.
Topics: Bronchial Fistula; Humans; Pleural Diseases; Pneumonectomy; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35393787
DOI: 10.1111/1759-7714.14404 -
The Journal of Thoracic and... May 2021
Topics: Bronchi; Fistula; Humans; Printing, Three-Dimensional; Stents; Trachea
PubMed: 32334885
DOI: 10.1016/j.jtcvs.2020.03.064 -
Medicine Apr 2016Pulmonary arteriovenous fistulas (PAVFs) are rare. Diffuse type PAVFs with pulmonary arterial hypertension (PAH) are even rarer and can elude anatomy imaging like a... (Review)
Review
Pulmonary arteriovenous fistulas (PAVFs) are rare. Diffuse type PAVFs with pulmonary arterial hypertension (PAH) are even rarer and can elude anatomy imaging like a plain chest film or a computed tomography. The rapid blood flow that ensues due to lack of a capillary bed leads to various degrees of ischemia depending on the number and size of the PAVF. This is a case report of diffuse PAVF in a patient with PAH.This case report describes a patient with recurrent hemoptysis and chest pain. Systemic examination was unremarkable except for P2 attenuation on auscultation. Echocardiograghy showed confirmed pulmonary hypertension with mild dilation of right atrium and ventricle and a tricuspid regurgitation pressure gradient of 40 mm Hg and ruled out congenital heart diseases. Right heart catheterization revealed precapillary PAH with mean pulmonary arterial pressure of 88 mm Hg. Pulmonary angiography showed enlarged pulmonary arterial trunk and diffuse spiral tortuous pulmonary arterial branches indicting diffuse PAVFs. The patient was diagnosed as PAH and began treatment of 25 mg tid of sildenafil.The case highlights a rare and unique presentation of PAH.
Topics: Adult; Arteriovenous Fistula; Humans; Hypertension, Pulmonary; Male; Pulmonary Artery; Pulmonary Veins
PubMed: 27057843
DOI: 10.1097/MD.0000000000003177 -
Korean Journal of Radiology Nov 2019To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential...
OBJECTIVE
To evaluate the natural course of coronary-to-pulmonary artery fistula (CPAF) detected on coronary computed tomography angiography (CCTA) and to propose potential treatment strategies.
MATERIALS AND METHODS
In this retrospective multicenter study, we assessed the CCTA reports of 188 CPAF patients evaluated between March 2009 and June 2016. Fifty-seven patients were excluded because their follow-up (FU) periods were less than 2 years. Information regarding demographic characteristics, past history, treatment method, and the occurrence of major adverse cardiac events (MACE) during the FU period was collected. We analyzed the morphologic features of CPAF and the various factors associated with surgical treatment. Patients who had undergone FU CCTA after being diagnosed with CPAF were assessed for the presence of morphological changes on FU imaging.
RESULTS
The median age of the study population was 63.0 years (range, 57.0-72.0 years), and the median FU period was 5.72 years (range, 4.08-6.96 years). The most common origin of the CPAF was both coronary arteries in 76 (58.0%) cases. An aneurysm or aneurysms was/were present in 41 (31.3%) cases. Fifty-four (41.2%) fistulas were less than 2 mm in size. Eight patients underwent surgery, and 123 (93.9%) patients received optimal medical treatment (OMT). The fistula size was significantly different between the two treatment groups ( = 0.013) and was the only factor associated with surgical treatment (odds ratio = 1.14, = 0.021). Only one patient in the OMT group reported MACE during the FU period due to preexisting coronary artery disease. Twenty-nine patients (22.1%) underwent FU CCTA after CPAF diagnosis, with a median FU period of 3.81 years. None of the patients in the OMT group demonstrated morphological changes in the CPAF on FU imaging.
CONCLUSION
Most CPAFs identified on CCTA have a favorable prognosis. Observation with OMT is usually an appropriate strategy. Fistula size is a possible determinant for surgical treatment.
Topics: Aged; Aneurysm; Coronary Angiography; Coronary Artery Disease; Coronary Vessels; Female; Fistula; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Prognosis; Pulmonary Artery; Retrospective Studies
PubMed: 31606954
DOI: 10.3348/kjr.2019.0331