Treatment of Post-Ablation Bronchopleural Fistula Using Percutaneous Synthetic Hydrogel Surgical Sealant: Initial Experi
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TECHNICAL NOTE
NON-VASCULAR
Treatment of Post-Ablation Bronchopleural Fistula Using Percutaneous Synthetic Hydrogel Surgical Sealant: Initial Experience of Safety and Efficacy Puja Shahrouki1 • Jonathan Barclay1 • Sarah Khan1 • Scott Genshaft1 • Fereidoun Abtin1 • Charles McGraw1 • Donny Baek2 • Barbara Nickel1 • Robert Suh1
Received: 30 June 2020 / Accepted: 21 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose Bronchopleural fistula is a rare but serious complication of lung ablation, as it is difficult to treat and is associated with a high mortality rate. Standard therapy often relies on surgical pleurodesis, which can be particularly problematic in patients with poor baseline lung function. A minimally invasive treatment option for bronchopleural fistula may offer an alternative to surgery for appropriate patients. This case series describes the
& Jonathan Barclay [email protected] Puja Shahrouki [email protected] Sarah Khan [email protected] Scott Genshaft [email protected]
technique, safety and efficacy of percutaneously administered synthetic hydrogel surgical sealant in the treatment of post-ablation bronchopleural fistula in five patients. Materials and methods Retrospective chart review was carried out in five consecutive patients identified to have had BPF after lung ablation between 2009 and 2017 who were treated with percutaneous administration of synthetic hydrogel surgical sealant using CT guidance. Results The procedure was successfully carried out in all patients without immediate complications, and complete resolution of air leak was achieved in four of five patients (80%). Up to the most recent follow-up, no evidence of delayed complications or recurrent air leak was present (follow-up range 1 week–8 years). Conclusion The authors’ initial experience shows that targeted surgical sealant is a potentially safe and effective alternative treatment of postablation persistent air leak. Keywords Bronchopleural fistula Ablation Sealant Pneumothorax
Fereidoun Abtin [email protected] Charles McGraw [email protected]
Introduction
Donny Baek [email protected]
A bronchopleural fistula (BPF) is a pathologic communication between the tracheobronchial tree and the pleural space which may lead to intractable pneumothorax, respiratory failure, empyema and even death [1]. BPF often presents as a pneumothorax lasting 5–7 days post-chest tube insertion, termed a persistent air leak (PAL) [2]. Although BPF is a relatively rare complication following lung ablations, with a reported incidence of up to 0.6% [3–7], mortality rates of 15.4–70% have been reported [8–10]. Additional risk factors for BPF formation include
Barbara Nickel [email protected] Robert Suh [email protected] 1
Department of Radiological Sciences, David Geffen School of Medicine At UCLA, Los Angeles, CA, USA
2
Department of Radiology, Torrance Memorial M
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