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Management of Alveolar-Pleural FistulaEndobronchial Application of Synthetic Hydrogel: A Complex Medical and Surgical Problem

Ali I. Musani, MD, FCCP; Hervé Dutau, MD
Author and Funding Information

From the Division of Pulmonary, Critical Care and Sleep Medicine (Dr Musani), National Jewish Health; and the Thoracic Endoscopy Unit (Dr Dutau), Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital.

CORRESPONDENCE TO: Ali I. Musani, MD, FCCP, National Jewish National Jewish Health, J-225, Molly Blank, 1400 Jackson St, Denver, CO 80206; e-mail: MusaniA@NJHealth.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts: Dr Musani is the site principal investigator for the Spiration EBV humanitarian use study at National Jewish Health, Denver Colorado. Dr Dutau reports that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):590-592. doi:10.1378/chest.14-2202
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Extract

Alveolar-pleural fistula (APF) and bronchopleural fistula (BPF) are uncommon yet frustrating medical and surgical problems with high morbidity and mortality. They may originate spontaneously or be encountered after bronchoscopy or thoracic surgery. However, they are almost always caused by an underlying pulmonary pathology, which seems to be the most important prognostic factor.

Reparative surgeries are never a desired first therapeutic option for APF or BPF. Pleurodesis with chemicals such as talc and thoracic surgery have had high failure rates.1 Unfortunately, pleural and bronchscopic interventions have had limited success as well. Bronchoscopic options for APF and BPF have been marred by technical problems, although their conceptual foundation is appealing. Airway occluding devices and agents have been used for decades. These modalities include endobronchial Watanabe spigots (Novatech), gelfoams, endobronchial valves, and synthetic hydrogel.

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