Interventional Bronchus Occlusion Using Amplatzer Devices – A Promising Treatment Option for Children with Persistent Air Leak

Abstract

Background: Persistent air leak (PAL) is a severe complication of secondary spontaneous pneumothorax (SSP). Surgical interventions are usually successful when medical treatment fails, but can be associated with significant complications and loss of potentially recoverable lung parenchyma. Methods: Retrospective analysis of efficacy and safety of interventional bronchus occlusions (IBO) using Amplatzer devices (ADs) in children with PAL secondary to SSP. Results: Six patients (four males, 4–15 years of age) underwent IBO using ADs as treatment for PAL. Necrotizing pneumonia (NP) was the most common cause (n=4) of PAL. Three patients were previously healthy and three suffered from chronic lung disease. All patients required at least two chest tubes prior to the intervention for a duration of 15–43 days and all required oxygen or higher level of ventilatory support. In three cases, previous surgical interventions had been performed without success. All children improved after endobronchial intervention and we observed no associated complications. All chest tubes were removed within 5–25 days post IBO. In patients with PAL related to NP (n=4), occluders were removed bronchoscopically without re-occurrence of pneumothorax after a mean of 70 days (IQR: 46.5–94). Conclusion: IBO using ADs is a safe and valuable treatment option in children with PAL independent of disease severity and underlying cause. A major advantage of this procedure is its less invasiveness compared to surgery and the parenchyma- preserving approach.

Zusammenfassung

Hintergrund: Die persistierende Luftleckage stellt eine schwere Komplikation eines sekundären Spontanpneumothorax (SSP) dar. Chirurgische Interventionen sind bei erfolgloser konservativer Therapie oft erfolgreich aber können mit schweren Komplikationen und dem Verlust von potentiell erholungsfähigem Lungengewebe behaftet sein. Ziel: Retrospektive Analyse über die Effektivität und Sicherheit von interventionellen Bronchus-Okklusionen (IBO) mit Amplatzer Devices (ADs) bei Kindern mit persistierender Luftleckage. Ergebnise: Bei 6 Patienten (4 männlich, Alter 4–15 Jahre) wurde eine IBO zur Therapie einer persistierenden Luftleckage durchgeführt. Die nekrotisierende Pneumonie (NP) war die häufigste zugrundeliegende Ursache einer persistierenden Leckage (n=4). 3 Kinder waren zuvor gesund, bei 3 Kindern lag eine chronische Lungenerkrankung vor. Alle Patienten benötigten vor Intervention mindestens 2 Thoraxdrainagen für 15–43 Tage und alle Kinder benötigten Sauerstoff oder eine zusätzliche Atemunterstützung. Bei 3 Patienten erfolgten zuvor erfolglose chirurgische Interventionen. Es traten keine Komplikationen im Zusammenhang mit der IBO auf. Alle Patienten profitierten von der Prozedur, die Thoraxdrainagen konnten nach 5–25 Tagen gezogen werden. Bei allen Kindern mit persistierender Luftleckage aufgrund einer NP (n=4) wurden die ADs nach durchschnittlich 70 Tagen (IQR:46.5–94) entfernt ohne dass ein Pneumothorax-Rezidiv auftrat. Schlussfolgerung: Die IBO mithilfe von ADs stellt unabhängig von der Ursache und Krankheitsschwere ein vielversprechendes und sicheres Therapieverfahren zur minimal-invasiven Behandlung von Kindern mit persistierender Luftleckage dar. Vorteile dieser Prozedur im Vergleich zu operativen Verfahren sind die geringe Invasivität und der parenchymerhaltende Ansatz.

Key words

air leak - persistent bronchopleural fistula - interventional bronchus occlusion - secondary spontaneous pneumothorax - pneumothorax - Amplatzer devices

Schlüsselwörter

Luftleckage - Persistierende bronchopleurale Fistel - interventionelle Bronchusokklusion - sekundärer Spontanpneumothorax - Pneumothorax - Amplatzer Okkluder

^*Katharina Schütz and Christoph M Happel contributed equally to the manuscript.

Publikationsverlauf

Eingereicht: 31. August 2021
Eingereicht: 31. August 2021

Angenommen: 15. November 2021

Artikel online veröffentlicht:
03. Januar 2022

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