Percutaneous vascular plug in management of an acquired broncho pleural cutaneous fistula.

IF 1.2 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ajay Alex, Praveen A, Niwin George, Vinu C V, Radhika Devi B, Neetha Jose
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引用次数: 0

Abstract

Background: Bronchopleural fistula (BPF) / broncho pleural cutaneous fistula is an abnormal communication between the peripheral bronchial tree and pleural space which can further also open to the skin surface. It is associated with significant morbidity and mortality in addition to poor quality of life. Management requires a multidisciplinary approach with careful evaluation to choose the best approach to treatment.

Case presentation: A 36-year-old male presented with a left chest wall tumor with multiple surgeries and CT revealing a left apico-posterior segment broncho pleural cutaneous fistula. Various options for the management of the BPCF including surgery and bronchoscopic occlusion were considered however an IR approach was planned. Plan was for vascular plug occlusion with/without glue embolization of the apico-posterior segmental bronchus. A 6F sheath was placed under direct vision and a 12 mm CERA plug was deployed. After plain plug occlusion, there were no signs of air leak. Various options for management including surgery and bronchoscopy procedures are limited in patients with poor pulmonary reserve. The IR approach offers the advantage of doing the procedure under real-time fluoroscopy, and no airway compromise. However, literature describes the use of glue to seal the interstices of the device which if not sealed was a cause of recurrence later. In our case, we report the percutaneous use of a CERA vascular plug as the sole device, especially since it has a polytetrafluoroethylene (PTFE) membrane which ensures occlusion, in addition to its titanium nitride coating which improves epithelialization. This ensures sustained occlusion as the sole agent, unlike other devices including the Amplatzer vascular plug.

Conclusions: This highlights the relatively easy percutaneous route and the first report of CERA vascular plug usage for managing a case of broncho pleural cutaneous fistula.

经皮血管栓塞治疗后天性支气管胸膜皮瘘。
背景:支气管胸膜瘘(BPF) /支气管胸膜皮瘘是外周支气管树与胸膜间隙之间的异常通道,并可进一步向皮肤表面开放。除了生活质量差外,它还与显著的发病率和死亡率有关。管理需要多学科的方法,仔细评估,以选择最好的治疗方法。病例介绍:一名36岁男性,左胸壁肿瘤,多次手术,CT显示左顶后段支气管胸膜皮瘘。治疗BPCF的各种选择包括手术和支气管镜闭塞,但计划采用IR方法。计划采用血管塞闭塞术,对支气管顶后段进行/不进行胶栓塞。将6F护套置于直接视野下,并部署了12 mm的CERA桥塞。单纯封堵后,没有空气泄漏的迹象。在肺储备不良的患者中,包括手术和支气管镜检查在内的各种治疗选择是有限的。红外入路提供了在实时透视下进行手术的优势,并且不会损害气道。然而,文献描述了使用胶水来密封装置的间隙,如果不密封是后来复发的原因。在我们的病例中,我们报告了经皮使用CERA血管塞作为唯一装置,特别是因为它有一个聚四氟乙烯(PTFE)膜,确保闭塞,除了它的氮化钛涂层,促进上皮化。与Amplatzer血管塞等其他设备不同,这确保了持续的闭塞作为唯一的代理。结论:这突出了相对容易的经皮途径和CERA血管塞用于治疗一例支气管胸膜皮瘘的首次报道。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CVIR Endovascular
CVIR Endovascular Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
2.30
自引率
0.00%
发文量
59
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