Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

Slebos, Dirk‐Jan; Klooster, Karin; Ernst, Armin; Herth, Felix J.F.; Kerstjens, Huib A. M.

doi:10.1378/chest.11-0730

Cited by 170 publications

(174 citation statements)

References 34 publications

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“…Small early trials indicated the safety and effectiveness of LVRC (60,61). A prospective European multicenter single-arm study involving 60 patients with bilateral heterogeneous emphysema found that FEV 1 , results on the 6MWT, and scores on the SGRQ improved significantly at the 1-year follow-up (62).…”

Section: Lvrcmentioning

confidence: 99%

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Wang

et al. 2016

BST

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Section: Lvrcmentioning

confidence: 99%

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Wang

et al. 2016

BST

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“…Larger, valid studies are primarily still in progress. Nevertheless, the rate of peri-interventional complications is apparently comparable with that of EBV [28]. While there is less knowledge about therapy with coils than about that with EBV, it constitutes the sole approved ELVR method when ELVR with EBV is not an option due to the presence of "collateral ventilation" (CV, see below).…”

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confidence: 99%

Lung Volume Reduction in Pulmonary Emphysema from the Radiologist’s Perspective

Doellinger

Huebner

Kuhnigk

et al. 2015

Fortschr Röntgenstr

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Pulmonary emphysema causes decrease in lung function due to irreversible dilatation of intrapulmonary air spaces, which is linked to high morbidity and mortality. Lung volume reduction (LVR) is an invasive therapeutical option for pulmonary emphysema in order to improve ventilation mechanics. LVR can be carried out by lung resection surgery or different minimally invasive endoscopical procedures. All LVR-options require mandatory preinterventional evaluation to detect hyperinflated dysfunctional lung areas as target structures for treatment. Quantitative computed tomography can determine the volume?percentage of emphysematous lung and its topographical distribution based on the lung?s radiodensity. Modern techniques allow for lobebased quantification that facilitates treatment planning. Clinical tests still play the most important role in post-interventional therapy monitoring, but CT is crucial in the detection of postoperative complications and foreshadows the method?s high potential in sophisticated experimental studies. Within the last ten years, LVR with endobronchial valves has become an extensively researched minimally-invasive treatment option. However, this therapy is considerably complicated by the frequent occurrence of functional interlobar shunts. The presence of ?collateral ventilation? has to be ruled out prior to valve implantations, as the presence of these extraanatomical connections between different lobes may jeopardize the success of therapy. Recent experimental studies evaluated the automatic detection of incomplete lobar fissures from CT scans, because they are considered to be a predictor for the existence of shunts. To date, these methods are yet to show acceptable results. Key points: ??Today, surgical and various minimal invasive methods of lung volume reduction are in use. ??Radiological and nuclear medical examinations are helpful in the evaluation of an appropriate lung area. ??Imaging can detect periinterventional complications. ??Reduction of lung volume has not yet been conclusively proven to be effective and is a therapeutical option with little scientifc evidence. Citation Format: ??Doellinger F, Huebner RH, Kuhnigk JM et?al. Lung Volume Reduction in Pulmonary Emphysema from the Radiologist?s Perspective. Fortschr R?ntgenstr 2015; 187: 662???675

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“…These factors have led to a search for less invasive methods that may potentially achieve the same benefits as surgical lung volume reduction. These methods include installation of endobronchial valves [4][5][6] or lung sealant [7,8] into affected lobes, thermal vapour ablation of selected lobes [9,10] or "coiling" of the worst affected lung regions [11,12]. For valves to be effective, a whole lobe should be targeted, and there must be no collateral ventilation with other lobes [13,14].…”

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When small is better: volume reduction in severe emphysema

Folch

Hillerdal

2015

Eur Respir J

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@ERSpublications What are our options for lung volume reduction treatment in patients with severe emphysema? http://ow.ly/PgQLVSevere emphysema radically diminishes quality of life. The disease is a result of destruction of lung parenchyma and is most commonly associated with cigarette smoke exposure or the congenital absence of α 1 -antitrypsin. The elastic fibres of the lung, which in a healthy state strive to retract the lungs, are particularly affected. The inward force determined by these fibres is balanced by the chest wall, which strives to push outwards. The result is a finely balanced system where only minimal work is needed in quiet breathing. Emphysema results in a loss of elasticity of the lungs, and thus the inward traction, while the outward force of the thorax remains unopposed, resulting in lung hyperinflation. Further, the small airways, that in normal lungs are kept open and wide by the elastic recoil from the lung parenchyma [1, 2], will have predilection for collapse due to the diminished elasticity of emphysema. Thus, even mild exertion may result in dynamic hyperinflation with air trapping adding to the increased work of breathing. In the 1950s it was shown that removal of emphysematous regions of the lung could considerably enhance lung function and quality of life by improving the total elasticity of the lungs [1]. If successful, residual volume is diminished, small airways collapse is reduced, and the chest will be less hyperinflated allowing the respiratory muscles to work more efficiently.Surgical lung volume reduction was extensively studied and its efficacy proven around the millennium shift [3]. It is now rarely performed, probably due to a high incidence of serious and even life-threatening complications. These factors have led to a search for less invasive methods that may potentially achieve the same benefits as surgical lung volume reduction. These methods include installation of endobronchial valves [4][5][6] or lung sealant [7,8] into affected lobes, thermal vapour ablation of selected lobes [9,10] or "coiling" of the worst affected lung regions [11,12]. For valves to be effective, a whole lobe should be targeted, and there must be no collateral ventilation with other lobes [13,14]. The aim is to induce atelectasis of the lobe. Severe complications are rare, but acute pneumothorax and repeated infections are well-documented. One advantage is the reversibility: the valves are easily removed bronchoscopically. Larger studies have shown statistically significant differences, but have failed to show clinically meaningful differences. However, in subgroups with high heterogeneity and complete fissures [4][5][6], and some small series [15,16], the results have been quite good. It is also a well-established method for treating pleuro-pulmonary fistulas [17]. Coiling is used, especially in Germany, and is promising; however, we still await a cost/benefit analysis on a larger multicentre trial. This method is in practice irreversible but is independent of collateral ventilation.In this...

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Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

Cited by 170 publications

References 34 publications

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Lung Volume Reduction in Pulmonary Emphysema from the Radiologist’s Perspective

When small is better: volume reduction in severe emphysema

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