An Intraatrial Thrombus and Pulmonary Thromboembolism as a Late Complication of Percutaneous Vertebroplasty

Lim, Kyoung Ja; Yoon, Seung Zhoo; Jeon, Yun Seok; Bahk, Jae Hyon; Kim, Chong S.; Lee, Jong Hwan; Ha, Jin

doi:10.1213/01.ane.0000256974.84535.7a

Cited by 48 publications

(31 citation statements)

References 13 publications

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“…Many serious complications with this procedure have been reported, including: leakage of, or acute respiratory failure associated with, polymethyl methacrylate; radiculopathy; spinal cord compression; pedicle fracture; pulmonary embolism intra-arterial thrombus; aortic aneurysm; aortic embolism of cement; pyogenic spondylitis; epidural and subdural cement leakage; posterior spinal epidural abscess; and infected vertebroplasty. [13][14][15][16][17][18][19][20] Although the procedure has a quite high success rate in providing immediate and significant pain relief, Yang et al reported that 22 patients with PVP required revision surgery upon presentation of new symptoms postoperatively. 21 The major complication rate associated with PVP is less than 1%, but 16.6% of patients experienced new-onset VCF after PVP during the 24-78-month follow-up period in our previous studies.…”

Section: Discussionmentioning

confidence: 99%

Treatment of repeated and multiple new-onset osteoporotic vertebral compression fractures with teriparatide

Liu

Lee

et al. 2012

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Treatment of repeated and multiple new-onset osteoporotic vertebral compression fractures with teriparatide

Liu

Lee

et al. 2012

Journal of Clinical Neuroscience

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“…Beside PMMA-cement embolism, a concomitant fatty bone marrow embolism might be discussed as a potential cofactor, since the insertion of cement volume inevitably causes some expulsion of bone marrow [17]. Cement propagation via paravertebral veins into the inferior vena cava and pulmonary embolism has been described in several case reports as possible cause for hypotension, arrhythmia, and hypocapnia [17][18][19][20][21]. In our particular case, the beginning of the clinical symptoms was 30 min after completion of the procedure.…”

Section: Discussionmentioning

confidence: 99%

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

et al. 2008

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The aim of this study was to analyze the technical results, the extraosseous cement leakages, and the complications in our first 500 vertebroplasty procedures. Patients with osteoporotic vertebral compression fractures or osteolytic lesions caused by malignant tumors were treated with CT-guided vertebroplasty. The technical results were documented with CT, and the extraosseous cement leakages and periinterventional clinical complications were analyzed as well as secondary fractures during follow-up. Since 2002, 500 vertebroplasty procedures have been performed on 251 patients (82 male, 169 female, age 71.5 +/- 9.8 years) suffering from osteoporotic compression fractures (n = 217) and/or malignant tumour infiltration (n = 34). The number of vertebrae treated per patient was 1.96 +/- 1.29 (range 1-10); the numbers of interventions per patient and interventions per vertebra were 1.33 +/- 0.75 (range 1-6) and 1.01 +/- 0.10, respectively. The amount of PMMA cement was 4.5 +/- 1.9 ml and decreased during the 5-year period of investigation. The procedure-related 30-day mortality was 0.4% (1 of 251 patients) due to pulmonary embolism in this case. The procedure-related morbidity was 2.8% (7/251), including one acute coronary syndrome beginning 12 h after the procedure and one missing patellar reflex in a patients with a cement leak near the neuroformen because of osteolytic destruction of the respective pedicle. Additionally, one patient developed a medullary conus syndrome after a fall during the night after vertebroplasty, two patients reached an inadequate depth of conscious sedation, and two cases had additional fractures (one pedicle fracture, one rib fracture). The overall CT-based cement leak rate was 55.4% and included leakages predominantly into intervertebral disc spaces (25.2%), epidural vein plexus (16.0%), through the posterior wall (2.6%), into the neuroforamen (1.6%), into paravertebral vessels (7.2%), and combinations of these and others. During follow-up (15.2 +/- 13.4 months) the secondary fracture rate was 17.1%, including comparable numbers for vertebrae at adjacent and distant levels. The presence of intradiscal cement leaks was not associated with increased adjacent fracture rates. CT-guided vertebroplasty is safe and effective for treatment of vertebral compression fractures. CT-fluoroscopy provides an excellent control of the posterior vertebral wall. The number of cement leakages alone is not directly associated with clinical complications. However, even small volumes of pulmonary PMMA embolism might be responsible for the fatal outcome in cases with underlying cardiopulmonary insufficiency.

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“…One case report presented evidence of thrombus attached to bone cement retrieved from the right atrium nearly five years post vertebroplasty. [9] Endovascular or surgical removal is indicated in patients with evidence of cardiac bone cement embolism and hemodynamic compromise. Features favoring percutaneous removal include fragments that are small and linear.…”

Section: Discussionmentioning

confidence: 99%

Glue masquerading as a catheter: Retrieval of embolized vertebroplasty cement

Narayanan

Matthews

2018

CRIM

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Identification of foreign body objects may be difficult based on imaging characteristics. History is essential to making a diagnosis. Cement leakage is a common complication of percutaneous vertebroplasty and the optimal management for cement embolism remains unknown. This report presents a case of a 72-year-old female with asymptomatic pulmonary cement embolism, which was partially retrieved via a percutaneous endovascular approach.

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An Intraatrial Thrombus and Pulmonary Thromboembolism as a Late Complication of Percutaneous Vertebroplasty

Cited by 48 publications

References 13 publications

Treatment of repeated and multiple new-onset osteoporotic vertebral compression fractures with teriparatide

Treatment of repeated and multiple new-onset osteoporotic vertebral compression fractures with teriparatide

CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

Glue masquerading as a catheter: Retrieval of embolized vertebroplasty cement

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