Korean J Radiol.  2017 Jun;18(3):519-525. 10.3348/kjr.2017.18.3.519.

Effectiveness of Ambulatory Tru-Close Thoracic Vent for the Outpatient Management of Pneumothorax: A Prospective Pilot Study

• Kim YP
• Haam SJ
• Lee S
• Lee GD
• Joo SM
• Yum TJ
• Lee KH

• KMID: 2427307
• DOI: http://doi.org/10.3348/kjr.2017.18.3.519

Abstract

OBJECTIVE
This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax.
MATERIALS AND METHODS
From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16-64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance.
RESULTS
Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0-5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3-13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016.
CONCLUSION
TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

Keyword

Pneumothorax; Thoracic vent; Tru-Close; Outpatient management

MeSH Terms

Adolescent
Adult
Catheters
Drainage/instrumentation/*methods
Female
Follow-Up Studies
Humans
Lung/physiopathology
Male
Middle Aged
Outpatients
Pilot Projects
Pneumothorax/*surgery
Prospective Studies
Recurrence
Young Adult

Figure

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  Fig. 1 Thoracic vent.External dimensions of thoracic vent are 9.5 (length) × 2.5 (width) × 2 cm (height). Thoracic vent comprises flexible urethane catheter with outer diameter of 11-or 13-Fr and length of 10–13 cm and removable in-line trocar connected to 1-way valve. Red-colored diaphragm movement represents pneumothorax drainage according to gradient between intrathoracic and extracorporeal pressures.

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  Fig. 2 Thoracic vent insertion under fluoroscopic guidance.A. 21-gauge Chiba needle (arrow) is inserted into second to fourth intercostal space in midclavicular line. Following confirmation of needle position within pleural space under bi-plane fluoroscopic guidance, 0.018-inch hair-wire (arrowhead) and yellow sheath are introduced sequentially. B, C. Guide wire is then exchanged for 0.035-inch radiofocus stiff wire (arrow), and thoracic vent device is inserted over-wire with 7-Fr dilator.

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  Fig. 3 Kaplan-Meier analysis of long-term freedom from recurrence after thoracic vent insertion.

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