B46-15 Amplatzer Vascular Plugs to the Rescue of Bronchopleural Pleural Fistula and Persistent Air Leak

Abstract Introduction Persistent air leak (PAL) and bronchopleural fistula (BPF) are difficult to treat in those with comorbidities or who are unfit for surgery and general anesthesia (GA). Limited literature reports that Amplatzer vascular plugs (AVPs) are a feasible, flexible bronchoscopic option for BPF closure. Case report Patient 1: A 61-year-old man with diabetes mellitus presented with necrotising pneumonia (NP) involving right middle and lower lobes, complicated by loculated pyopneumothorax (LP) and persistent air leak (Cerfolio grade 4) despite antibiotics and dual pigtail drainage. Flexible bronchoscopy (FB) localised the leak to the right lower lobe, and two type 2 AVPs (8 mm in the apical segment and 12 mm blocking all four basal segments) were deployed under local anaesthesia (LA) as the patient was unfit for surgery or GA. The air leak resolved immediately, with full lung expansion. Patient 2: A 51-year-old man with right lower lobe NP and LP developed BPF and PAL (Cerfolio grade 4). A 12 mm AVP was placed under FB in LA in the right lower lobe basal bronchi, resulting in complete cessation of the air leak and radiologic resolution. The AVPs were removed under FB at three months in patient 1 and at two months in patient 2, with no recurrence at six months. Both patients recovered without complications, demonstrating successful FB deployment of AVP for BPF. Discussion AVPs offer a controlled, retrievable, and lung-sparing method for BPF closure using FB under LA or conscious sedation, making them particularly valuable in patients unfit for surgery or GA. AVPs are available in multiple diameters (4-16 mm), allowing customisation for both central and peripheral BPFs. The device is generally sized 30-40% larger than the airway lumen or fistula opening to ensure a secure seal and reduce the risk of migration. Multiple plugs may be deployed if required, and the device can be repositioned before final release, enabling precise placement. Compared with coils and glues, AVPs provide superior stability and do not rely on inflammatory adhesion. In contrast to endobronchial valves, AVPs cause complete occlusion rather than one-way decompression, making them particularly effective in large BPFs. AVPs are also substantially less expensive and more widely available in resource-limited settings. Complications such as migration, granulation, or infection are uncommon, and importantly, AVPs can be safely removed under FB later. The absence of recurrence after removal in our cases supports the efficacy, safety, and retrievability of this technique. This abstract is funded by: None