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• W4387247921 abstract "SESSION TITLE: Accessing the Mediastinum to Pleural Space SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: For lung and mediastinal lesions that are concerning for malignancy, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the mainstay of diagnosis and staging. A limitation of EBUS-TBNA includes lesions adjacent to the vasculature, as these lesions are not accessible without traversing the pulmonary vessels. In such cases, a transvascular approach (EBUS-TVNA) is necessary to access these lesions. Prior series have demonstrated the safety and efficacy of this technique. We present a case series from our single-center experience in which interventional pulmonologists performed EBUS-TVNA during diagnostic bronchoscopy. METHODS: We performed a retrospective review of diagnostic bronchoscopy in which EBUS-TVNA was utilized to access intra-thoracic lesions that were inaccessible by standard bronchoscopy or EBUS-TBNA. Cases were performed between March 2019 and March 2023. All patients for whom EBUS-TVNA was considered had antiplatelet or anticoagulant agents held before the procedure and had preoperative echocardiograms showing normal pulmonary artery pressures. In each procedure, before the first pass for TVNA, the EBUS balloon was inflated to ensure complete distal airway occlusion was possible in case of bleeding. Rapid on-site evaluation (ROSE) was used in all cases. Data regarding the indication, location, lesion size, yield, and complications were collected. RESULTS: Over the course of four years, seven diagnostic bronchoscopies included EBUS-TVNA sampling. Endobronchial ultrasound-guided transbronchial needle aspiration was still performed when clinically indicated. Transvascular sampling of the lesions was done through the right upper lobe pulmonary artery, right inferior pulmonary vein, right lower lobe pulmonary artery in two cases, and left lower lobe pulmonary artery in three cases. The mean procedure time was 79 minutes. The diagnostic yield was 100%. Malignant results were confirmed in all but one of the cases on final cytopathology. Granulomas were identified in the case without malignancy. There was no significant blood loss or immediate post-procedure complications. CONCLUSIONS: From our single-center case series, we conclude that in carefully selected patients, EBUS-TVNA is a feasible option with high diagnostic potential and without excessive risks in the hands of experienced bronchoscopists. These findings are in line with the previously published case series. CLINICAL IMPLICATIONS: For lesions in anatomically difficult locations, EBUS-TVNA performed by interventional pulmonologists presents a safe option with a high yield which could obviate the need for additional procedures. Larger, prospective trials should be performed to explore the safety and diagnostic potential of EBUS-TVNA. DISCLOSURES: Consultant relationship with VisionAir Solutions Please note: 02/2022 - 03/2022 Added 12/01/2022 by Sameer Avasarala, source=Web Response, value=Consulting fee No relevant relationships by Damarys Hernandez No relevant relationships by Tanmay Panchabhai No relevant relationships by Olivia Rizzo No relevant relationships by Benjamin Young" @default.
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• W4387247921 date "2023-10-01" @default.
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• W4387247921 title "ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSVASCULAR NEEDLE ASPIRATION: EXPERIENCE FROM A GROWING INTERVENTIONAL PULMONARY PROGRAM" @default.
• W4387247921 doi "https://doi.org/10.1016/j.chest.2023.07.3414" @default.
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