2009
DOI: 10.1007/s00586-009-1073-y
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Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature

Abstract: Balloon kyphoplasty and percutaneous vertebroplasty are relatively recent procedures in the treatment of painful vertebral fractures. There are, however, still some uncertainties about the incidence and treatment strategies of pulmonary cement embolisms (PCE). In order to work out a treatment strategy for the management of this complication, we performed a review of the literature. The results show that there is no clear diagnostic or treatment standard for PCE. The literature research revealed that the risk o… Show more

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Cited by 290 publications
(223 citation statements)
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“…[1][2][3][4][5][6] Occasionally, cement that has leaked into the veins may migrate into the lungs causing PCE. Although most PCEs remain asymptomatic, serious and even fatal sequelae have occasionally been reported.…”
mentioning
confidence: 99%
“…[1][2][3][4][5][6] Occasionally, cement that has leaked into the veins may migrate into the lungs causing PCE. Although most PCEs remain asymptomatic, serious and even fatal sequelae have occasionally been reported.…”
mentioning
confidence: 99%
“…Symptomatic patients, on the other hand, may be managed with heparin followed by warfarin for at least 6 months, which is hypothesized to allow endothelialization of the thrombogenic cement material and prevent progressive pulmonary artery occlusion [5]. Overall, this case highlights an unusual form of pulmonary emboli and underscores the need to consider a broad differential diagnosis for chest pain and shortness of breath in the setting of recent operative interventions, including vertebroplasty and kyphoplasty.…”
Section: Discussionmentioning
confidence: 92%
“…Cement extrusion has been estimated to occur in 3-70 % of vertebroplasties and 8-33 % kyphoplasties, with radiographically evident pulmonary cement emboli produced in 4.6 % of cases [3,4]. While there are no standards of care for the treatment and management of pulmonary cement emboli, asymptomatic individuals may be effectively managed conservatively with close clinical monitoring [5].…”
Section: Discussionmentioning
confidence: 99%
“…In cases of symptomatic or central embolisms, however, treatment includes initial heparinization and a following 6-month coumarin therapy should be proceeded. A continuous anticoagulation therapy after the initial 6 months of treatment does not seem to be indicated and due to the associated bleeding complications in the prevalent older population it is actually contraindicated [4]. Even after review of the literature, it is not possible to derive a clear treatment strategy for the treatment of pulmonary cement embolisms.…”
Section: Discussionmentioning
confidence: 99%
“…Besides surgical removal, treatment options include administration of heparin i.v. or s.c., observation of the clinical spontaneous progress or coumarin treatment for 3-6 months after the occurrence of the embolism [4].…”
Section: Discussionmentioning
confidence: 99%