B46-01 Bridging the Gap: Amplatzer Occluder as a Life Saving Alternative in Bronchopleural Fistula Management

Abstract Introduction Bronchopleural fistulas (BPF) are abnormal communications between the bronchial tree and pleura, resulting in persistent air leaks associated with high morbidity and mortality. They are most commonly a complication of lung resection, with incidence up to 20% post-pneumonectomy and 0.5% post-lobectomy. One-way endobronchial valves (EBV) provide a minimally invasive method for managing postoperative air leaks, serving as a bridge to definitive surgical management. Presentation We report the case of a 39-year-old healthy male, who presented with hypoxia secondary to Streptococcus pneumoniae pneumonia requiring intubation. His course progressed to ARDS, complicated by empyema, right middle lobe necrosis and trapped lung necessitating decortication and right lower lobectomy. After extubation, he developed a large right hydropneumothorax with worsening hypoxia requiring re-intubation. Bronchoscopy revealed right lower lobe stump dehiscence with continuous air leak and persistent hydropneumothorax. The defect was too large for EBV placement, and he was not a surgical candidate due to intolerance of single-lung ventilation. A 10-mm Amplatzer device was placed, resulting in reduced air leak, with adjunctive Surgicel application when leak recurred. The device remained in place during tracheostomy and rehabilitation, allowing stabilization and definitive surgical repair with omental flap placement. Discussion Large BPFs following thoracic surgery often necessitate closure with muscle flap reinforcement. However, not all patients are suitable surgical candidates, in which case EBV placement is considered. Retrospective cohort analyses of EBVs show success rates up to 82.4% across various indications and 73.1% specifically for BPF management. We describe a unique case where both surgical repair and EBV placement were contraindicated. In such scenarios, Amplatzer occlusion devices represent an emerging bronchoscopic alternative. A retrospective series involving 72 patients and 83 devices reported short- and long-term safety and efficacy. Prospective studies provide additional support: Fruchter et al. achieved complete closure in all five patients treated with bronchoscopic Amplatzer Vascular Plugs placement, while Bai et al. demonstrated 100% technical success and 70% durable closure using ventricular septal defect occluders in a 10-patient cohort. In our patient, deployment of an Amplatzer device provided effective control of the persistent air leak, allowing for clinical stabilization and subsequent planning of a complex, staged thoracic intervention. Conclusion Amplatzer devices are a minimally invasive alternative for fistula closure, with high technical success and favorable safety profiles. Placement of an Amplatzer device for BPF is a valuable interim strategy, facilitating physiologic stabilization and enabling patients to tolerate curative surgical intervention. This abstract is funded by: None