Intracardiac and intrapulmonary cement embolisms after percutaneous vertebroplasty.
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ABSTRACT:
SUBMITTER: Wei Z
PROVIDER: S-EPMC10722014 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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Intracardiac and intrapulmonary cement embolisms after percutaneous vertebroplasty.
Quantitative imaging in medicine and surgery 20230920 12
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Project description:Percutaneous vertebroplasty has emerged as an increasingly popular intervention for managing a variety of common spinal conditions. Nevertheless, kyphoplasty cement can accidentally leak into paravertebral venous plexus, then travel to the right heart chambers through the venous system. We report an exceedingly rare case of an intracardiac cement embolism, likely an inadvertent complication of a recent percutaneous lumbar vertebroplasty. A mobile mass was incidentally found during a cardiac catheterization procedure, most likely in right atrium. Subsequent computed tomography angio chest and cardiac imaging confirmed a floating foreign body in the right atrium, which was then retrieved successfully through an endovascular approach. Gross examination of the removed body confirmed a bone cement-like material. Intracardiac cement embolism warrants serious attention as it may result in catastrophic cardiac complications.Learning objectiveIntracardiac cement embolism is an extremely rare, but potentially life-threatening complication after percutaneous vertebroplasty. The bone cement fragments accidentally leak into paravertebral plexus and then via venous system into the right-sided cardiac chambers and pulmonary arteries.
| S-EPMC9352404 | biostudies-literature
Project description:Background and purposeThe reported incidence of PCE during PV varies, depending on the sensitivity of diagnostic tests used. To assess the true incidence of PCE, we performed native chest CT during follow-up in a large proportion of patients from the VERTOS II trial.Materials and methodsVERTOS II is a prospective multicenter randomized controlled trial comparing PV with conservative therapy in 202 patients. After a mean follow-up of 22 months (median, 21 months; range, 6-42 months), 54 of 78 patients (69%) with 80 vertebrae treated with PV underwent native chest CT to detect possible PCE. The presence, location, number, and size of PCE were recorded. In addition, the presence of pulmonary parenchymal changes adjacent to PCE was noted. Possible risk factors for PCE, such as age, sex, number of treated vertebrae, cement volume per vertebra, and presence and location of perivertebral cement leakage, were evaluated.ResultsPCE was detected in 14 of 54 patients (26% 95% CI, 16%-39%). All patients were asymptomatic. Cement emboli were small and randomly distributed in peripheral small vessels. There were no reactive pulmonary changes. Cement leakage in the azygos vein was the only risk factor for the occurrence of PCE (OR, 43; 95% CI, 5-396).ConclusionsSmall and clinically silent PCE occurred in a quarter of patients treated with PV. Cement leakage into the azygos vein was the only risk factor. With time, these small cement emboli remained inert, without inflammatory pulmonary response. Standard postprocedural CT or chest radiographs are not necessary.
| S-EPMC7966118 | biostudies-literature
Project description:PurposeThis study aimed to investigate the effect of precooling storage of bone cement in percutaneous vertebroplasty(PVP) for the patients with osteoporotic vertebral compression fracture (OVCF).MethodsA total of 207 OVCF patients who underwent PVP were included in this study. Two different storage methods for the bone cement were randomly utilized: an operating room (NT group, 23 °C) and a refrigerator (PC group, 4 °C). Clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. In addition, radiographic evaluations were performed using anterior vertebral height and Cobb angle.ResultsThe time of cement infusion was 10.8 ± 2.1 min in the PC group, which was significantly longer compared to the NT group (6.9 ± 1.8 min)(P < 0.0001). However, the postoperative VAS score was lower in the PC group than the NT group (P < 0.0001). Moreover, compared to the NT group, the cement distribution score and rate of cement touching both upper and lower vertebral endplates were higher in the PC group (P < 0.0001 and = 0.037, respectively). Additionally, the anterior vertebral height was higher in the PC group compared to the NT group at both the 2-day postoperative assessment and the final follow-up (P = 0.046 and 0.026, respectively). Lastly, the rates of cement leakage and re-compression were lower in the PC group (P = 0.016 and 0.034, respectively) compared with the NT group.ConclusionPrecooling storage of bone cement may prolong manipulation time in percutaneous vertebroplasty, optimize pain relief for patients, and mitigate the risk of bone cement leakage and re-compression.Trial registrationTrial registration number: ChiCTR2400092330. Retrospective registration date: 14/11/2024 ( www.chictr.org.cn ).
| S-EPMC11660442 | biostudies-literature
Project description:Objective Pulmonary cement embolism is a rare but underestimated complication of vertebroplasty due to the relative lack of study and examination. This study aims to investigate the incidence of pulmonary cement embolism in patients with spinal metastasis who undergo PVP with RFA and to analyze the relative risk factors. Methods A total of 47 patients were retrospectively included and classified into pulmonary cement embolism (PCE) group and non-pulmonary cement embolism (NPCE) group by comparing pre- and postoperative pulmonary CT scan images. The demographic and clinical information of the patients was obtained. Demographic data in the two groups were compared using the chi-square test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was used to identify risk factors related to pulmonary cement embolism. Results Pulmonary cement embolism was detected in 11 patients (23.4%), and all patients were asymptomatic and followed up regularly. Risk analysis showed that multiple segments (≥3, p=0.022), thoracic vertebrae (p=0.0008), and unipedicular puncture approach (p=0.0059) were risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra (p<0.0001). Vein leakage of cement was related to the integrity of the vertebral cortex. Conclusion The number of involved vertebrae, lesion location, and puncture approach are independent risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra. Surgeons should consider these factors when formulating therapeutic strategies.
| S-EPMC10196379 | biostudies-literature
Project description:BackgroundPercutaneous vertebroplasy (PVP) might lead to significant radiation exposure to patients, operators, and operating room personnel. Therefore, radiaton exposure is a concern. The aim of this study was to present a remote control cement delivery device and study whether it can reduce dose exposue to operators.MethodsAfter meticulous preoperative preparation, a series of 40 osteoporosis patients were treated with unilateral approach PVP using the new cement delivery divice. We compared levels of fluoroscopic exposure to operator standing on different places during operation. group A: operator stood about 4 meters away from X-ray tube behind the lead sheet. group B: operator stood adjacent to patient as using conventional manual cement delivery device.ResultsDuring whole operation process, radiation dose to the operator (group A) was 0.10 ± 0.03 (0.07-0.15) μSv, group B was 12.09 ± 4.67 (10-20) μSv. a difference that was found to be statistically significant (P < 0.001) between group A and group B.ConclusionNew cement delivery device plus meticulous preoperative preparation can significantly decrease radiation dose to operators.
| S-EPMC4236675 | biostudies-literature
Project description:BackgroundVertebroplasty is a procedure most commonly used for vertebral compression fractures. Although it is a relatively safe procedure, complications have been reported. Cement embolism is seen in 2.1%-26% of patients after percutaneous vertebroplasty.Case presentationa 38-year-old male who was diagnosed with cushing's syndrome, underwent percutaneous vertebroplasty for his thoracic osteoporotic compression fractures. 24-hours following vertebroplasty, he presented to emergency department with acute-onset dyspnea and chest pain. Chest radiography showed an opaque linear lesion in left pulmonary artery which was suggestive of cement embolism. Pulmonary spiral CT-scan further confirmed the diagnosis. The patient's symptoms improved over time, and warfarin was started with close cardiopulmonary assessments for indicators of cement embolus removal.Conclusionin patients with pulmonary cement embolism, conservative treatment may be recommended rather than a surgical removal except when the obstruction is extensive enough to cause hemodynamic changes. Given that all the related studies have suggested that pulmonary thromboembolism can occur as a complication due to bone cement leakage, discovering new cement alternatives and/or injection devices, seems beneficial.
| S-EPMC6068333 | biostudies-literature
Project description:IntroductionDuring percutaneous vertebroplasty (PV), perivertebral cement leakage frequently occurs. There is some concern that cement deposits may migrate towards the lungs via the veins during follow-up. We used baseline and follow-up computed tomography (CT) to assess the incidence and extend of late cement migration in a large consecutive patient cohort.MethodsVERTOS II is a prospective multicenter randomized controlled trial comparing PV with conservative therapy for osteoporotic vertebral compression fractures (OVCFs). Patients assigned to PV had baseline postprocedural CT scans of the treated vertebral bodies. After a mean follow-up of 22 months, 54 of 78 patients (69%) had follow-up CT. CT scans were analyzed and compared for perivertebral venous, discal, and soft tissue leakage.ResultsPerivertebral cement leakage occurred in 64 of 80 treated vertebrae (80%; 95% CI, 70% to 87%). All patients remained asymptomatic. Perivertebral venous leakage was present in 56 vertebrae (88%), mostly in the anterior external venous plexus (46 of 56, 82%). Discal leakage occurred in 22 of 64 vertebrae (34%) and soft tissue leakage in two of 64 (4%). Mean injected cement volume in vertebrae with leakage was higher (4.5 versus 3.7 cm(3), p = 0.04). Follow-up CT scan showed unchanged perivertebral cement leakages without late cement migration.ConclusionPerivertebral cement leaks during PV for OVCFs occurred frequently in the VERTOS II trial. Cement leakage occurred more frequently with higher injected volumes. However, all patients remained asymptomatic, and late cement migration during follow-up did not occur. Standard postprocedural CT of the treated vertebral body in PV is not necessary.
| S-EPMC3016147 | biostudies-literature
Project description: Not available
| S-EPMC8691793 | biostudies-literature
Project description:BackgroundCement leakage into venous blood posed significant challenge to surgeons. The aim of the study was to create a Peking University First Hospital Score (PUFHS) which could evaluate the probability of vascular cement leakage among spine metastases patients following percutaneous vertebroplasty.MethodsThe study retrospectively enrolled 272 spine metastases patients treated with percutaneous vertebroplasty. We randomly extracted all enrolled patients as the training or validation group and baseline characteristic comparison was assessed between the two groups. Creation of the PUFHS was performed in the training group and validation of the PUFHS was performed in the validation group.ResultsOf all the 272 patients, the total number of included vertebrae was 632 and the median treated levels were 2 per patient. Vascular cement leakage occurred in 26.47% (72/272) of patients. The baseline characteristics were comparable between the two groups (P > 0.05). Three risk predictors (primary cancer types, number of treated vertebrae levels, and vertebrae collapse) were included in the PUFHS. The area under the receiver operating characteristic curve (AUROC) of the PUFHS was 0.71 in the training group and 0.69 in the validation group. The corresponding correct classification rates were 73.0 and 70.1%, respectively. The calibration slope was 0.78 (95% confidence interval[CI]: 0.45-1.10) in the training group and 1.10 (95% CI: 0.73-1.46) in the validation group. The corresponding intercepts were 0.06 (95% CI: - 0.04-0.17) and - 0.0079 (95% CI: - 0.11-0.092), respectively.ConclusionsVascular cement leakage is common among spine metastases after percutaneous vertebroplasty. The PUFHS can calculate the probability of vascular cement leakage, which can be a useful tool to inform surgeons about vascular cement leakage risk in advance.
| S-EPMC8254210 | biostudies-literature
Project description:ObjectivesTo investigate the epidemiology of cement leaks and further develop an algorithm to detect the high risk of cement leaks among advanced cancer patients with metastatic spinal disease treated with percutaneous vertebroplasty.MethodsThis study retrospectively analyzed 309 patients with metastatic spinal disease treated with percutaneous vertebroplasty. Patients were randomly divided into a training group and a validation group. In the training group, 13 potential characteristics were analyzed for their abilities to predict cement leaks. Discal cement leakage and paravertebral cement leakage were excluded from the analysis. Those characteristics identified as having significant predictive value were used to develop a predictive algorithm. Internal validation of the algorithm was performed based on discrimination and calibration qualities.ResultsOverall, cement leaks occurred in 61.17% (189/309) patients. Among the 13 characteristics analyzed, younger age (P = 0.03), extravertebral bone metastases (P = 0.02), increased number of treated vertebrae levels (P < 0.01), and cortical osteolytic destruction in the posterior wall (P = 0.01) were included in the algorithm. This algorithm generates a score between 0 and 16 points, with higher scores indicating a higher risk of cement leakage. The area under the receiver operating characteristic curve (AUROC) value for the algorithm was 0.75 in the training group and 0.69 in the validation group. The mean correct classification rates for the training and validation groups were 73.5% and 64.9%, respectively, and the corresponding P-values of the goodness-of-fit test were 0.70 and 0.50.ConclusionsCement leaks are common in patients with metastatic spinal disease treated with percutaneous vertebroplasty. The present study proposed and internally validated an algorithm that can be used to screen patients at high risk of cement leakage.
| S-EPMC8134071 | biostudies-literature