Transient Arterial Hypotension Induced by Polymethylmethacrylate Injection during Percutaneous Vertebroplasty

Vasconcelos, Cristiana; Gailloud, Philippe; Martin, Jean Baptiste; Murphy, Kieran J.

doi:10.1016/s1051-0443(07)61584-x

Cited by 87 publications

(33 citation statements)

References 2 publications

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“…17,67,109 Leakage of unreacted monomer, or less likely polymethyl methacrylate or venography dye, may produce systemic effects resulting in toxic reaction or allergic effects leading to acute arterial hypotension or fever. 34,50,74,75,110 Although there is considerable leakage reported during both procedures (Figure 4), the actual leakage rate might have been underreported because of reporting bias or the detection method used. 48,111,112 Schmidt et al 112 reported low leakage detection rates and only showed fair interobserver reliability using radiographs.…”

Section: What Are the Complications Associated With The Procedure?mentioning

confidence: 99%

Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies

Hulme¹,

Krebs²,

Ferguson³

et al. 2006

Spine

665

490

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Section: What Are the Complications Associated With The Procedure?mentioning

confidence: 99%

Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies

Hulme¹,

Krebs²,

Ferguson³

et al. 2006

Spine

665

490

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show abstract

“…This empirical limitation is based on the increasing incidence and severity of pulmonary complications when injecting larger volumes. Pulmonary fat embolization during vertebroplasty may lead to arterial hypotension, oxygen desaturation and arrhythmia [6][7][8][9]. Cardiovascular changes resulting from fat embolism are often transient, but may be fulminant, resulting in cardiac arrest and even death [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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

Benneker

Krebs²,

Boner

et al. 2010

Eur Spine J

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Clinically, the displacement of intravertebral fat into the circulation during vertebroplasty is reported to lead to problems in elderly patients and can represent a serious complication, especially when multiple levels have to be treated. An in vitro study has shown the feasibility of removing intravertebral fat by pulsed jet-lavage prior to vertebroplasty, potentially reducing the embolization of bone marrow fat from the vertebral bodies and alleviating the cardiovascular changes elicited by pulmonary fat embolism. In this in vivo study, percutaneous vertebroplasty using polymethylmethacrylate (PMMA) was performed in three lumbar vertebrae of 11 sheep. In six sheep (lavage group), pulsed jet-lavage was performed prior to injection of PMMA compared to the control group of five sheep receiving only PMMA vertebroplasty. Invasive recording of blood pressures was performed continuously until 60 min after the last injection. Cardiac output and arterial blood gas parameters were measured at selected time points. Post mortem, the injected cement volume was measured using CT and lung biopsies were processed for assessment of intravascular fat. Pulsed jet-lavage was feasible in the in vivo setting. In the control group, the injection of PMMA resulted in pulmonary fat embolism and a sudden and significant increase in mean pulmonary arterial pressure. Pulsed jet-lavage prevented any cardiovascular changes and significantly reduced the severity of bone marrow fat embolization. Even though significantly more cement had been injected into the lavaged vertebral bodies, significantly fewer intravascular fat emboli were identified in the lung tissue. Pulsed jet-lavage prevented the cardiovascular complications after PMMA vertebroplasty in sheep and alleviated the severity of pulmonary fat embolism.

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“…Pulmonary cement embolism is a reason for cardiovascular complications during vertebroplasty 1,2 . But cardiovascular changes, such as arterial hypotension, oxygen desaturation, and arrhythmia, have also been observed in the absence of cement embolism and have been attributed to bone marrow fat embolization [3][4][5][6] . Cardiovascular changes resulting from fat embolism are often transient, but may be fulminant, resulting in cardiac arrest and even death [6][7][8][9] .…”

mentioning

confidence: 99%

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

Krebs

Ferguson

Hoerstrup

et al. 2008

The Journal of Bone & Joint Surgery

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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.

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Transient Arterial Hypotension Induced by Polymethylmethacrylate Injection during Percutaneous Vertebroplasty

Cited by 87 publications

References 2 publications

Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies

Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies

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

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

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