Alveolar-pleural fistulas causing persistent air leaks are associated with prolonged hospital stays and high morbidity. Prior guidelines recommend surgical repair as the gold standard for treatment, albeit a solution with limited success. In patients who have recently undergone thoracic surgery or in which surgery would be contraindicated based on severity of illness, there has been a lack of treatment options.
This review describes a brief history of treatment guidelines for persistent air leaks. In the past 20 years, newer and less invasive treatment options have been developed. Aside from supportive care, the literature includes anecdotal successful reports using fibrin sealants, ethanol injection, metal coils, and Watanabe spigots. More recently, larger studies have demonstrated success with chemical pleurodesis, autologous blood patch pleurodesis, and endobronchial valves. This manuscript will describe in detail these treatment options including post-procedural adverse events.
Further research, including randomized controlled trials with comparison of these options are needed as well as long-term follow-up for these interventions.