Endobronchial Valve Treatment for Prolonged Air Leaks of the Lung: A Case Series

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

“…1 Endobronchial valve placement remains the only endobronchial intervention available, with documented literature supporting use in air leaks. [2][3][4] Although other interventions such as glue and coiling have been reported, the American College of Chest Physicians' statement on prolonged air leaks in pneumothorax suggest avoidance of these endobronchial interventions. 5 Our multidisciplinary team pursued endobronchial valve placement in this patient with a persistent air leak after recurrent pneumothorax in the setting of an advanced refractory malignancy.…”

“…4 Re- ports of off-label endobronchial valve use continue to increase and have been documented in numerous situations at this point, including a heterogeneous case series of persistent air leaks. 2 In patients in whom the leak can be isolated to an anatomic area (subsegmental, segmental, or lobar bronchi), endobronchial valve use provides a nonsurgical approach to the treatment of prolonged air leaks. In situations in which the leak cannot be identified, options such as prolonged intercostal tube drainage or pleurodesis may be required.…”

“…4 Endobronchial valve removal was performed secondary to the known pneumonia risk related to endobronchial valve placement 2,3 in an attempt to minimize potential complications in this immunocompromised patient. However, after evidence of recurrence and plans for hospice referral, destination therapy appeared quite appropriate.…”

Management options for the complicated pleural space

“…Travaline et al demonstrated complete resolution in 45 % of patients with persistent BPF and significant reduction of the air leak in an additional 40 % [88]. Gillespie and colleagues were able to achieve successful resolution of persistent air leaks a median of 1 day after placement of endobronchial valves [89].…”

Surgical Management of Prolonged Air Leak in Patients with Underlying Emphysema

“…A balloon tipped catheter is used to provide selective bronchial occlusion to determine the segmental or subsegmental airway that results in the greatest decrease in air leak. The endobronchial valve is then inserted in these airways (98,99). The results of the two largest series on endobronchial valve placement are summarized below, and the overall conclusion is it is a promising mode of therapy particularly for patients with no other therapeutic options.…”