Innovative Method for Amplatzer Device Implantation in Patients With Bronchopleural Fistulas

Abstract Background: Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach the Sheath-free method (SFM the aim of the present report was to explore the reliability and advantages of SFM for AD implantation.Methods: We improved the existing placement methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without the use of general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67±6.19 years [mean ± SD]) had bronchopleural fistulas sealed using the SFM for AD implantation. Results: Closure was successfully performed in all 6 patients with the SFM, and the average duration of operation was 16.17 minutes (16.17±4.67 minutes [mean ± SD]). Five patients achieved complete occlusion after the operation, and 1 patient who had multiple fistulas did not. No patients died due to operation complications and BPF recurrence. The average follow-up time was 13.2 months (range: 10-17 months).Conclusion: We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF sealing, and patient symptoms significantly improved after sealing.