Endobronchial Valve Placement as Destination Therapy for Recurrent Pneumothorax in the Setting of Advanced Malignancy

Abstract

The development of a persistent air leak after pneumothorax can be encountered in patients with underlying structural lung disease. In those with advanced malignancy or other comorbidities, the ability to tolerate general anesthesia and thoracoscopic procedures may limit definitive management. We describe the case of a 68-y-old male with refractory acute myelogenous leukemia presenting with recurrent secondary spontaneous pneumothorax and persistent air leak related to an underlying fungal pneumonia. Endobronchial valve placement allowed for timely chest tube removal and discharge from the hospital, as well as avoidance of a thoracoscopic procedure and pleurodesis.

Endobronchial Valves for Challenging Air Leaks

“…Indeed, the latter individual was the 1 patient in this series who experienced a recurrent air leak after valve removal. He underwent repeat EBV placement as destination therapy and had no recurrence of pneumothorax in the remaining 7 months of his life [15]. The safety of this strategy is supported by the initial studies in which valves were placed and left in situ until planned pulmonary resection, experience in studies in which valves were placed permanently for emphysema [5][6][7]26], and in reports of valves left in place for prolonged periods for other medical conditions [27].…”

“…All consecutive patients undergoing EBV placement for persistent air leak from October 2011 through May 2013 were included. Seven patients were previously reported [13][14][15]. Patients with prolonged air leaks were evaluated for EBV placement by a multidisciplinary thoracic surgery and interventional pulmonology team at a single institution.…”

Use of One-Way Intrabronchial Valves in Air Leak Management After Tube Thoracostomy Drainage

“…No standard protocol for air leak management was utilized (before or after IBV placement), which is a limitation of our study; however, we believe that allows for an accurate assessment of current clinical management issues. The Spiration IBV remains approved for use in the United States only under compassionate use for postsurgical PAL [12], and the literature supports IBV use for postoperative PAL [17][18][19]; however, numerous off-label reports also exist [20][21][22][23][24][25][26]. We were unable to discover descriptions of unsuccessful IBV use in the literature, a metric we have now provided.…”