Clinical characteristics and management of cardiac and/or pulmonary cement embolus after percutaneous vertebroplasty: a single center experience

Background: Cardiac and/or pulmonary cement embolus (CPCE) caused by the leakage of bone cement after percutaneous vertebroplasty (PVP) are rare but are lethal complications in patients with vertebral compression fracture (VCF). Literature in this field is limited, and guidelines for the management of such complications are unclear. This study aimed to review our center's experience. Methods: Medical records (clinical characteristics and management) and imaging data (X-ray findings, CT findings, and fluoroscopic findings) of 12 patients with CPCE after PVP between October 2015 and July 2018 at our hospital were collected and examined retrospectively. Their health conditions were also evaluated through a telephone follow-up survey. Results: Twelve patients with an average age of 76.8 +/- 8.5 years were included in our study. One patient who had a cardiac cement embolus and one patient who suffered from an inferior vena cava (IVC) cement embolus were successfully treated via percutaneous retrieval. Ten asymptomatic patients with pulmonary cement embolus (PCE) were managed with conservative observation. All of the patients were alive and remained asymptomatic during the follow-up period (median time, 6.5 months; range, 1-50 months). Conclusions: More attention should be paid to the possibility of development of CPCE. For patients with cardiac cement embolus, open heart surgery should be considered as a preferred treatment, and percutaneous procedure could be used as an alternative treatment for patients with surgical contraindication or other surgical high-risk factors. For patients with an IVC cement spike, percutaneous retrieval could be recommended. Careful observation and clinical follow-up could be recommended for patients with asymptomatic peripheral or central PCEs.