Amplatzer occluder closure of postoperative bronchopleural fistula: a three-case series

Abstract

Bronchopleural fistula (BPF) remains one of the most feared complications after major thoracic surgery because it is associated with prolonged hospitalization, empyema, respiratory failure, and substantial mortality. In selected patients, bronchoscopic closure with cardiac occlusion devices originally developed for closure of septal defects may offer a minimally invasive alternative to repeat surgery.

Case presentation. We report three patients with postoperative BPF treated with an Amplatzer occluder. Case 1 developed bronchial stump insufficiency in the setting of chronic pleural empyema years after right upper lobectomy. The placement of a bronchoscopic occluder resulted in adequate occlusion of the BPF for 3 months following the procedure. Case 2, a multimorbid patient with squamous cell carcinoma, developed an early post-lobectomy BPF. Multiple prior interventions, including re-thoracotomy and segmental endobronchial valve treatment, provided only temporary control. Subsequent occluder placement at a newly identified stump fistula achieved only transient closure, and the patient passed away later from cardiorenal multiorgan failure under palliative conditions. Case 3 developed recurrent empyema secondary to bronchial stump insufficiency after right pneumonectomy. Initial bronchoscopic placement of the occluder was technically unsuccessful because of pronounced lateral angulation of the fistula. Definitive closure was achieved using a combined video-assisted thoracoscopic surgery (VATS)-guided and bronchoscopic-assisted occluder implantation with adjunctive fibrin glue installation.

Conclusions. Amplatzer occluder placement is a feasible minimally invasive option for selected postoperative BPFs. Successful treatment depends not only on fistula size, but also on anatomy, angulation, local infection control, and the patient’s global physiological reserve. In anatomically complex fistulas with pronounced angulation, a hybrid VATS-guided and bronchoscopic-assisted approach may enable successful occluder implantation when purely bronchoscopic placement is not feasible.