Endovascular management of massive broncho pulmonary fistula – A series of 28 cases

  • Khanna N
  • Rao S
  • Ajuluchukwu O
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Abstract

Background: BronchoePulmonary Fistula (BPF) occurs in 2-3 per 100,000 population. They could be congenital or acquired and are usually associated with Hereditary HemorrhagicTelengiectasia (70 %). They could be either single or multiple, central (PA to LA Fistula) or peripheral (PA to PV Fistula). Usually they are asymptomatic (30 - 55 %) but can present with cyanosis, dyspnea on exertion, neurological symptoms (migraine, vertigo, TIA, paresis, numbness, syncope, confusion, cerebral abscess, seizures) or haemoptysis and haemothorax. Diagnosis is confirmed by contrast (air bubble) echocardiography or CT / conventional angiography. Pneumonectomy, lobectomy, local excision and ligation of the pulmonary artery used to be the available treatments but carried a significant morbidity and mortality. Currently, Endovascular Treatment is emerging as a promising alternative and our series is perhaps the largest one. Methods: The diagnosis is confirmed by angiography, which is performed in many views to delineate the point of communication. Long sheath is introduced and a Berman catheter is then advanced via the long sheath and the balloon is inflated. The large flow across the BPF guides the balloon catheter to the branch supplying the BPF. The Fistula is closed either by coil embolization (Bioptome assisted) or Amplatzer ASD Device or Vascular Plug (I, II, III). The saturations (ideally PO2) usually normalizes after complete occlusion. Results: N : 28; Age : 26 +/- 3.5 Yrs Central : 3/28; Peripheral : 25/28 Coil Embolisation : 8; Device Closure : 23 (In 3 patients, additional coils were used) Technical Success : 100%; Repeat Procedure : 5/28 Spo2 Pre Op : 70 +/- 2%; Spo2 Post Op : 95.4 +/- 3%. Conclusions: Most of the massive BPF can be managed by endovascular techniques and pneumonectomy or other major surgery can be avoided. This series of 28 successfully treated cases of Central and Peripheral Bronchopulmonary AV Malformations is probably one of the largest series. (Table Presented).

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Khanna, N. N., Rao, S., & Ajuluchukwu, O. (2014). Endovascular management of massive broncho pulmonary fistula – A series of 28 cases. Indian Heart Journal, 66, S96. https://doi.org/10.1016/j.ihj.2014.10.266

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