Safety and diagnostic yield of echobronchoscopy guided transvascular punction

Background: Puncture sampling techniques guided by echobronchoscopy (EBUS) and echoendoscopy (EUS) have been established as an essential tool for the diagnosis of thoracic lesions and lung cancer staging. Adenopathies located in stations 5 (aortopulmonary window) and 6 (para-aortic region) and central parenchymal lesions are usually inaccessible with this technique because they require crossing large vessels, and a surgical approach is often required. One of the possibilities to overcome this limitation is the Transvascular Needle Aspiration puncture (TVNA), which has previously proven to be a safe method. Methods: We performed an observational retrospective study of patients that underwent a TVNA in the course of the habitual clinical practice in our center. Patient filliation and clinical information, location of the target lesion, diagnosis by EBUS/EUS-TVNA, the final diagnosis, complications, the validity of the sample and other data was collected. Results: 18 patients, mean age of 64, 72% males, were analyzed. The target lesion was a lymph node in 39%, lung nodule in 33%, and a parenchymal mass in the rest of cases. The most frequently crossed vessel was the left pulmonary artery or its branches in 55% of cases ; the most frequent location was station 5. The sample was valid in 67% of the cases, reaching a pathological diagnosis in 63% of the cases. In addition, in 39% of cases, the pathological diagnosis could only be achieved with the TVNA puncture. Only two cases of mild self-limited bleeding were reported. Conclusions: According to our data, TVNA punction via EBUS or EUS is a safe procedure, without added complications, and with a high diagnostic yield, avoiding much aggressive approaches.