RT info:eu-repo/semantics/doctoralThesis
T1 Diagnóstico y cierre de fístula alvéolo- pleural con válvulas endobronquiales unidireccionales
A1 Vega Sánchez, Blanca de
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Neumotórax
K1 Fistula
K1 Fistula
K1 Alveolar-Pleural
K1 Alveolo-pleural
K1 Algorithm
K1 Algoritmo
K1 Bronchoscopy
K1 Broncoscopia
K1 32 Ciencias Médicas
AB Alveolar-pleural fistulas (APF) represent a diagnostic and therapeutic challenge. The objective of this work is the design of a diagnostic algorithm for determining APF in patients who are not candidates for surgical treatment through bronchoscopy, and subsequent endoscopic treatment through implantation of endobronchial valves (EBV). Method: Prospective non-randomized study of 47 patients diagnosed APF. Diagnostic procedures (computed axial tomography, balloon occlusion test, selective endobronchial oxygen insufflation and/or selective bronchography) and therapeutic procedures (endobronchial valve implantation) were performed. The diagnostic rate was recorded, as well as the success and complications of the implanted EBVs. Results: The determination of the anatomical location of APF by computed axial tomography, balloon occlusion test, selective endobronchial oxygen insufflation and selective bronchography was 31.9%, 57.1, 81 and 63.4% of the sample respectively. . The combination of these diagnostic tests made it possible to determine the location of APF in 91.5% of the sample. Complications were recorded in 6 patients (12.8% of cases), all of them resolved.EBV were implanted in 40 patients. Its use presented a success rate of 80% with an adequate safety profile. Three complications were detected during the endoscopic implantation and 6 patients with complications during the established follow-up, most of them without clinical relevance.The analysis of the etiologies of APF revealed that the subgroup of patients affected by persistent air leak of post-surgical etiology treated with endobronchial valves achieved better results than the rest of the sample.Conclusions: The diagnosis and treatment of APF using flexible bronchoscopy is a useful method, with an adequate safety and efficacy profile.  The initial approach of the proposed diagnostic algorithm includes performing an axial tomography. In case of continuous air leak, the first endoscopic option is the balloon occlusion test; while if the leak is intermittent we recommend performing the selective endobronchial oxygen insufflation test and secondly selective bronchography (respective sensitivity 81% vs 63.4% and complications 8.1 vs 7.3%). Endoscopic treatment using endobronchial valves presents few complications with overall results close to 80% success.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/77389
UL https://uvadoc.uva.es/handle/10324/77389
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 09-sep-2025