Successful Percutaneous Retrieval of a Large Pulmonary Cement Embolus Caused by Cement Leakage During Percutaneous Vertebroplasty Case Report and Literature Review

Study Design. A case report and literature review. Objective. To present a case of dynamic detection of a large pulmonary cement embolus as it formed and migrated during percutaneous vertebroplasty, which was successfully managed by percutaneous endovascular retrieval. Summary of Background Data. Pulmonary embolism resulting from cement leakage after percutaneous vertebroplasty to treat osteoporotic vertebral compression fracture has been described rarely; however, the frequency of this complication may increase secondary to the expanding use of percutaneous vertebral augmentation techniques. Methods. The formation of a large embolus of acrylic cement and its migration into the pulmonary artery was observed in real time in a 55-year-old female with osteoporotic vertebral compression fracture of L4 during percutaneous vertebroplasty. Results. Pulmonary arteriography confirmed the presence of the cement embolism in the right pulmonary artery during the operation. Percutaneous endovascular retrieval of the cement fragments was performed successfully via an interventional catheter procedure and subsequent incision of the femoral vein. The patient made an uneventful recovery. Conclusion. As illustrated by our case, large cement emboli may be primarily associated with technical aspects of the surgery. When considering the appropriate treatment strategy, percutaneous endovascular retrieval may be considered first. However, risks and benefits should be carefully evaluated on a case-by-case basis.