How to measure the size of the bronchial fistula?

Abstract

Introduction: Bronchial fistula (BF) after pneumonectomy – is a serious complication, associated with high mortality. Since the introduction in clinical practice the less invasive techniques for BF closure, namely vascular occluders, amplatzer sets, the abilities of BF closure have been rising. But the main issue for BF closure by the occluders is a proper selection of the device size, which defined by the BF features. Aims and Objectives: The aim of our study was to define the best method of BF measurement. Methods: Under a local anesthesia and bronchoscope control catheter sizing balloon was put in BF in such manner that x-ray plaque set up in the center of BF. Balloon was inflating by liquid contrast until the moment of waist appearing under X-ray control. Once the waist appeared, inflation of balloon was stopped and we measured the length and width of balloon waist in two projections. The size of amplatzer waist should be 30% bigger the BF size. Results: In such way we measured BF sizes in 8 of 13 patients, and these patients were successfully subjected to the procedure of occluder installation. In 5 of 13 patients the BF sizes were measured by fibrobronchoscopy (FBS) and CT-scans, and all of these 5 patients needed occluders reinstallation. Later we measured the sizes of these BF by sizing balloons and we found new sizes 30-50% bigger as compared with initial sizes, measured by CT and FBS. Reinstallation of occluders in these patients was successful and resulted in fistula closure in all cases. Conclusions: Of all the measurement methods we used, the measurement with the help of the sizing balloon and X-ray C-arm appeared to be the most accurate. The BF closure by occluders installation by this way was safe and reliable.