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

Abstract

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.

Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage

“…pulmonary bone marrow fat embolization, was characterized by a sudden (within 60 s after injection) and considerable ([50%) increase in pulmonary arterial pressure which is in accordance with previous investigations [13,17]. Pulmonary hypertension lasted for 9 min.…”

Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

“…In patients with multiple painful vertebral collapses, lowvolume multilevel vertebroplasty, consisting of injecting \3 ml PMMA (average 1.5 ± 0.5) in each treated vertebra, was performed. Our logic was that this would minimize the risk of fat embolism and avoid depression of hematopoiesis [25,26].…”

Short Update on Dysbaric Osteonecrosis: Concepts and Decompression Management

“…The role of lipid dissolution D deep-sea diving or are exposed to environments of high air pressures [1][2][3][4][5] . Dysbarism or Caisson Disease (CD) is characterized by an array of systemic complications involving soft tissues, the cardio-pulmonary, nervous, renal and musculoskeletal systems when individuals or experimental animals are brought back to normal atmospheric pressures without adequate decompression, even after a single hyperbaric exposure 1,6,7 . Dysbaric osteonecrosis (DON), one of the primary constituents of DCS, has been a subject of prolonged investigations to determine the precise patho-physiology of the affliction, and its prevalence and relationship with DCS.…”