Precision Closure of Postsurgical Bronchopleural Fistulas Using Vascular Plugs.

Background: Bronchopleural fistula (BPF) is a severe postoperative complication in thoracic surgery with high morbidity and mortality. Traditional surgical treatments are effective but invasive, highlighting the need for minimally invasive alternatives. The Amplatzer vascular plug (AVP), typically used for the embolization of targeted vessels, has been highlighted for its potential use in BPF closure. Methods: This study evaluated the use of AVPs II and IV for bronchoscopic closure of BPFs in 3 male patients after lobectomy or pneumonectomy. AVP II was used for fistulas >6 mm and AVP IV for those <6 mm. Procedures were performed under general anesthesia in the hybrid operating room using flexible bronchoscopy with fluoroscopic guidance. Results: Successful fistula closure was achieved in all cases without complications. Follow-up during 11 months (range, 3-22 months) confirmed stable device positioning, clinical improvement, and no 90-day mortality. Conclusions: AVP closure is a safe, effective, and minimally invasive approach for managing BPF, offering a promising first-line treatment option for patients unsuitable for traditional surgery. Further studies are required to validate these findings.