Vertebroplasty cement embolization into the venous system has long been recognized as a potential complication, but the true incidence of systemic embolization is unknown. Clinical presentations range from patients who are asymptomatic or have incidental findings on imaging to massive pulmonary embolism resulting in death. Optimal treatment is controversial and the natural history is unknown. We present the case of an 85-year-old female undergoing combined laminectomy and vertebroplasty with subsequent pulmonary embolism of the cement which was successfully retrieved from a percutaneous approach.

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Background:The majority of vascular complications during diagnostic coronary angiography occur while accessing the femoral artery. Angio‐Seal vascular closure devices are indicated for closure of arteriotomies of the femoral artery, but not when the puncture site is above or below the femoral artery.Hypothesis:Under certain circumstances, use of the Angio‐Seal closure device above or below the common femoral artery may be safe and effective.Methods:Consecutive patients at a single high‐volume medical center having documented high or low arteriotomies were closed using an Angio‐Seal closure device. Patients were chosen when they received a single arterial puncture, the arteriotomy was away from branch vessels, and the diameter of the artery at the site of sheath entry was of large enough caliber to suggest placement would be successful. Patients were then followed longitudinally for complications.Results:Sixty‐two patients had non–femoral artery sheath placement. Twenty‐two patients had “high” puncture sites, and 40 patients had “low” puncture sites. All were successfully closed using the Angio‐Seal vascular closure device and had no complications.Conclusions:Although not approved for placement in areas above or below the femoral artery, off‐label use of the Angio‐Seal arteriotomy closure may be safely performed when patient characteristics are favorable. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose. Neither author has a conflict of interest with St. Jude Medical or with the Angio‐Seal device.