Cardiovascular Changes after Pulmonary Cement Embolism: An Experimental Study in Sheep

Krebs, Jörg; Aebli, Nikolaus; Goss, Ben; Wilson, Kristin; Williams, Richard; Ferguson, Stephen J.

doi:10.3174/ajnr.a0499

Cited by 21 publications

(19 citation statements)

References 28 publications

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“…Calcium phosphate cement may provide a scaffold for clot formation or may initiate the coagulation cascade by surface contact activation and providing calcium ions, an important cofactor for coagulation. However, more recent studies have found no coagulation activation after both polymethylmethacrylate and calcium phosphate cement came in contact with circulating blood in vitro 31 and in vivo 32,33 . Quantification of thrombin-antithrombin complexes allows one to detect subtle degrees of coagulation activation.…”

Section: Discussionmentioning

confidence: 99%

Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty

Krebs

Ferguson

Hoerstrup

et al. 2008

The Journal of Bone & Joint Surgery

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Influence of bone marrow fat embolism on coagulation activation in an ovine model of vertebroplasty Abstract BACKGROUND: Intraoperative cardiovascular deterioration as a result of pulmonary embolization of bone marrow fat is a potentially serious complication during vertebroplasty. The release of fatty material and thromboplastin from the bone marrow cavity during vertebroplasty may activate the coagulation cascade resulting in thrombogenesis, and pharmacological prophylaxis may therefore prevent cardiovascular complications. Thus, the effects of bone marrow fat embolism on coagulation activation during vertebroplasty were investigated with use of an animal model. METHODS: Polymethylmethacrylate was injected into three lumbar vertebrae of six sheep in order to force bone marrow fat into the circulation. Invasive blood pressures and heart rate were recorded continuously until sixty minutes after the last injection. Cardiac output, arterial and mixed venous blood gas parameters, and coagulation parameters were measured at selected time-points. Postmortem lung biopsy specimens were assessed for the presence of intravascular fat. RESULTS: Embolization of bone marrow fat resulted in a sudden and dramatic increase in mean pulmonary arterial pressure and a decrease in mean arterial blood pressure. There were no significant changes in any coagulation parameter from before the injection to after the injection. Intravascular fat and bone marrow cells were present in all lung lobes. CONCLUSIONS: Injection of polymethylmethacrylate into vertebral bodies caused embolization of bone marrow fat with subsequent transient cardiovascular deterioration, but no changes in coagulation parameters were observed. Thromboembolism did not contribute to the observed cardiovascular changes.

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Section: Discussionmentioning

confidence: 99%

Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty

Krebs

Ferguson

Hoerstrup

et al. 2008

The Journal of Bone & Joint Surgery

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“…It is also possible that thromboembolism may also aggravate cardiovascular deterioration after PMMA embolism. In addition, it would be impossible to control the quantity of embolized cement [53].…”

Section: Intra-cardiac Embolism Leading To Cardiovascular Deteriorationmentioning

confidence: 99%

A Review of PMMA Bone Cement and Intra-Cardiac Embolism

Shridhar¹,

Chen²,

Khalil³

et al. 2016

Preprint

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Percutaneous vertebroplasty procedure is of major importance, given the significant increasing aging population and higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main features of PMMA bone cement on the heart, and the extent of influence of materials on cardiac embolism. Clinically, cement leakage results in life-threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case report.

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“…However, polymeric compounds cannot compete with pure ceramics on bioactivity [10,11,17,40], but using CPCs other drawbacks such as cement failure [38] or particle/ion release could lead to tremendous clinical risks like embolism [41]. The present study demonstrated, that special acrylic cement compositions can combine the good handling properties of common PMMA with a good degree of osteo-integration in vivo and positive effects in cell culture studies, where cell apposition and bone forming potential was investigated.…”

Section: Discussionmentioning

confidence: 76%

Evaluation of the in vitro cell-material interactions and in vivo osteo-integration of a spinal acrylic bone cement

Verrier

Hughes²,

Alves

et al. 2011

Eur Spine J

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Introduction Polymethylmethacrylate bone cements have proven performance in arthroplasty and represent a common bone filler, e.g. in vertebroplasty. However, acrylic cements are still subject to controversy concerning their exothermic reaction and osteo-integration potential. Therefore, we submitted a highly filled acrylic cement to a systematic investigation on the cell-material and tissueimplant response in vitro and in vivo. Materials and methods Cured Vertecem V? Cements were characterized by electron microscopy. Human bone marrow-derived mesenchymal stem cell morphology, growth and differentiation on the cured cement were followed for 28 days in vitro. The uncured cement was injected in an ovine cancellous bone defect and analysed 4 and 26 weeks post-implantation. Results The rough surface of the cement allowed for good stem cells adhesion in vitro. Up-regulation of alkaline phosphatase was detected after 8 days of incubation. No adverse local effects were observed macroscopically and microscopically following 4 and 26 weeks of implantation of the cement into drill-hole defects in ovine distal femoral epiphysis. Direct bone apposition onto the implant surface was observed resulting in extended signs of osteo-integration over time (35.2 ± 24.2% and 88.8 ± 8.8% at week 4 and 26, respectively). Conclusion Contrary to the established opinion concerning bony tissue response to implanted acrylic bone cements, we observed an early cell-implant in vitro interaction leading to cell growth and differentiation and significant signs of osteo-integration for this acrylic cement using standardized methods. Few outlined limitations, such as the use of low cement volumes, have to be considered in the interpretation of the study results.

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Cardiovascular Changes after Pulmonary Cement Embolism: An Experimental Study in Sheep

Cited by 21 publications

References 28 publications

Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty

Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty

A Review of PMMA Bone Cement and Intra-Cardiac Embolism

Evaluation of the in vitro cell-material interactions and in vivo osteo-integration of a spinal acrylic bone cement

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