Cement pulmonary embolism as a complication of percutaneous vertebroplasty in cancer patients

Abstract

BackgroundVertebroplasty is a minimally invasive procedure commonly performed for vertebral compression fractures secondary to osteoporosis or malignancy. Leakage of bone cement into the paravertebral venous system and cement pulmonary embolism (cPE) are well described, mostly in patients with osteoporosis. Little is known about the clinical sequelae and outcomes in cancer patients. In this study, we report our experience with cPE following vertebroplasty performed in cancer patients.MethodsRecords of all consecutive cancer patients who underwent vertebroplasty at our institution were retrospectively reviewed. The procedure was performed via percutaneous injection of barium-opacified polymethyl-methacrylate cement.ResultsA total of 102 cancer patients with a median age of 53 (19–83) years were included. Seventy-eight (76.5%) patients had malignant vertebral fractures, and 24 (23.5%) patients had osteoporotic fractures. Cement PE was detected in 13 (12.7%) patients; 10 (76.9%) patients had malignant fractures, and the remaining three had osteoporotic fractures. Cement PE was mostly asymptomatic; however, 5 (38.5%) patients had respiratory symptoms that led to the diagnosis. Only the five symptomatic patients were anticoagulated.Cement PE was more common with multiple myeloma (MM); it occurred in 7 (18.9%) of the 37 patients with MM compared with only three (7.3%) of the 41 patients with other malignancies. No difference in incidence was observed between patients with osteoporotic or malignant vertebral fractures.ConclusionsCement PE is a relatively common complication following vertebroplasty and is mostly asymptomatic. Multiple myeloma is associated with the highest risk. Large-scale prospective studies can help identify risk factors and clinical outcomes and could lead to better prevention and therapeutic strategies.

Clinical characteristics and management of cardiac and/or pulmonary cement embolus after percutaneous vertebroplasty: a single center experience

“…On the contrary, Blinc et al (16) performed an in vitro study and demonstrated that the surface of fresh or old cement does not accelerate platelet aggregation or plasma coagulation. In addition, patients with PCE received no anticoagulation therapy and remained asymptomatic during long-term follow-up (17,18), indicating that asymptomatic PCEs may be effectively managed with careful observation. Our results also demonstrated that patients with asymptomatic peripheral or central embolisms could be safely managed with careful observation and clinical follow-up.…”

Pulmonary cement embolism following balloon�kyphoplasty: The impact of a procedural complication in a�new era for lung cancer management

“…Mansour et al (2) recently published a paper regarding 102 cancer patients with vertebral fractures who underwent vertebroplasty with PMMA injection. Cement PCE was detected in 12.7% of patients; of these, 76.9% had malignant fractures, and the remaining 23.1%, a number of which had active cancer, had osteoporotic fractures.…”

“…Balloon kyphoplasty is a minimally invasive surgical procedure that allows the stabilization of compressive vertebral fractures (1). Patients with cancer represent a high-risk group for these fractures, considering not only the underlying disease, but also the prevalence of risk factors for osteoporosis in this population, including advanced age and corticosteroid therapy (2).…”

“…Pulmonary cement embolism (PCE) is a recognized complication resulting from distant leakage of cement (2), either by penetration into the venous plexuses or by retrograde migration through the arterial vessels into the aorta (3). Its exact prevalence is unknown, ranging between 2 and 26% according to the selected diagnostic imaging method (4).…”

Comparison of Percutaneous Vertebroplasty and Percutaneous Curved Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Distribution of Bone Cement and Complication

“…Since then, this minimally invasive treatment had been promoted as a stable treatment for osteoporotic vertebral compression fractures that can not be relieved by conservative treatment. As a routine method for the treatment of osteoporotic vertebral compression fractures, pvp can stabilize the spine and effectively relieve short-term pain [7][8][9]. However, its disadvantages as a common surgical method are still obvious: systemic complications of vertebroplasty are rare; fat embolism or arterial embolism may occur,;and epidural bleeding can also take place, but it is extremely infrequent [10,11].…”