Pulmonary cement embolism after percutaneous vertebroplasty in osteoporotic vertebral compression fractures: incidence, characteristics, and risk factors.

PURPOSE To prospectively evaluate the incidence of, characteristics of, and risk factors for pulmonary cement embolism after percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS Institutional review board approval and written informed consent were obtained. From June 2006 to September 2007, 75 patients (57 women, 18 men; mean age, 74.78 years; range, 48-93 years) who underwent 78 PVP sessions at 119 levels for osteoporotic VCFs were prospectively enrolled in this study. Computed tomographic (CT) scans of the chest and treated vertebrae were obtained after PVP. The presence, location, involved pulmonary arteries, number, and size of each pulmonary cement embolus were analyzed at CT. Possible risk factors were analyzed as follows: Age, injected cement volumes, and numbers of treated vertebrae were analyzed by using the Mann-Whitney U test; operators (radiologist or nonradiologist), level of treated vertebrae, guidance equipment, approach (uni- or bipedicular), presence of intravertebral vacuum clefts, and presence of paravertebral venous leakage were analyzed by using Pearson chi(2) and Fisher exact tests. RESULTS Pulmonary cement emboli developed in 18 (23%) of 78 PVP sessions and were detected in the distal to third-order pulmonary arteries. Only cement leakage into the inferior vena cava showed a statistically significant relationship to pulmonary cement embolism (P = .03). A higher frequency of pulmonary cement embolism was noted for the absence of intravertebral vacuum clefts, for the bipedicular approach, and for a nonradiologist operator with C-arm fluoroscopy (P > .05). CONCLUSION In osteoporotic VCFs, pulmonary cement embolism was detected in 23% of PVP sessions, developed in the distal to third-order pulmonary arteries, and was related to leakage into the inferior vena cava.

[1]  Y. Taeymans,et al.  Successful management of a large pulmonary cement embolus after percutaneous vertebroplasty: a case report. , 2003, Spine.

[2]  J. Takala,et al.  Severe Hypercapnia Due to Pulmonary Embolism of Polymethylmethacrylate During Vertebroplasty , 2004, Anesthesia and analgesia.

[3]  Y. Saida,et al.  Effect on partial pressure of oxygen in arterial blood in percutaneous vertebroplasty. , 2007, AJNR. American journal of neuroradiology.

[4]  D F Kallmes,et al.  Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. , 1997, AJNR. American journal of neuroradiology.

[5]  F. Gouin,et al.  Embolie pulmonaire au ciment au cours d'une vertébroplastie , 2004 .

[6]  R. Kuzo,et al.  Subsequent pulmonary embolism: risk after a negative helical CT pulmonary angiogram--prospective comparison with scintigraphy. , 2000, Radiology.

[7]  Seongtae Jeong,et al.  Acute Respiratory Distress Syndrome Associated With Pulmonary Cement Embolism Following Percutaneous Vertebroplasty With Polymethylmethacrylate , 2004, Spine.

[8]  K. Ahrar,et al.  Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. , 2004, AJR. American journal of roentgenology.

[9]  D. Han,et al.  Vertebroplasty: magnetic resonance findings related to cement leakage risk , 2007, Acta Radiologica.

[10]  E. Tutsch-Bauer,et al.  Fatal pulmonary cement embolism following percutaneous vertebroplasty (PVP). , 2005, Forensic science international.

[11]  I. Lieberman,et al.  An In Vivo Comparison of the Potential for Extravertebral Cement Leak After Vertebroplasty and Kyphoplasty , 2002, Spine.

[12]  H. Deramond,et al.  [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. , 1987, Neuro-Chirurgie.

[13]  B Padovani,et al.  Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. , 1999, AJNR. American journal of neuroradiology.

[14]  P. Heini,et al.  Asymptomatic diffuse pulmonary embolism caused by acrylic cement: an unusual complication of percutaneous vertebroplasty , 2003, Annals of the rheumatic diseases.

[15]  A. Evans,et al.  Vertebroplasty in patients with severe vertebral compression fractures: a technical report. , 2000, AJNR. American journal of neuroradiology.

[16]  X Demondion,et al.  Percutaneous vertebroplasty: state of the art. , 1998, Radiographics : a review publication of the Radiological Society of North America, Inc.

[17]  C. Akman,et al.  Pulmonary cement embolism: a complication of percutaneous vertebroplasty , 2007, Acta radiologica.

[18]  John M. Mathis,et al.  Percutaneous Vertebroplasty: Procedure Technique , 2006 .

[19]  K. Kuizenga,et al.  Anatomical and Pathological Considerations in Percutaneous Vertebroplasty and Kyphoplasty: A Reappraisal of the Vertebral Venous System , 2004, Spine.

[20]  K. Tiesenhausen,et al.  Cement embolization into the vena cava and pulmonal arteries after vertebroplasty: interdisciplinary management. , 2006, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[21]  J. Laredo,et al.  Complications of percutaneous vertebroplasty and their prevention , 2004, Skeletal Radiology.

[22]  J. Chiras,et al.  Percutaneous vertebroplasty for spinal metastases: complications. , 2006, Radiology.

[23]  M. Reiser,et al.  Pulmonary embolism: comprehensive diagnosis by using electron-beam CT for detection of emboli and assessment of pulmonary blood flow. , 2000, Radiology.

[24]  N. Bruder,et al.  [Pulmonary embolism of cement during vertebroplasty]. , 2004, Annales francaises d'anesthesie et de reanimation.

[25]  B. Cunningham,et al.  SB Charité Disc Replacement: Report of 60 Prospective Randomized Cases in a U.S. Center , 2003 .

[26]  S. H. Lee,et al.  Pulmonary Embolism of Polymethylmethacrylate After Percutaneous Vertebroplasty: A Report of Three Cases , 2002, Spine.

[27]  L. V. von Segesser,et al.  Management of pulmonary embolism during acrylic vertebroplasty. , 2002, The Annals of thoracic surgery.

[28]  R. Schmidt,et al.  Cement leakage during vertebroplasty: an underestimated problem? , 2005, European Spine Journal.

[29]  S. Belkoff,et al.  Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. , 2001, AJNR. American journal of neuroradiology.

[30]  D. Theodorou.  The intravertebral vacuum cleft sign. , 2001, Radiology.

[31]  R. Assaker,et al.  Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. , 1996, Radiology.