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Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep.

Abstract：

STUDY DESIGN:An experimental study of cardiovascular complications that arise during vertebroplasty was conducted. OBJECTIVE:To investigate the sequential occurrence of fat embolism and hypotension during vertebroplasty. SUMMARY OF BACKGROUND DATA:Vertebroplasty, the augmentation of vertebrae with polymethylmethacrylate, is a technique for treating osteoporotic compression fractures and achieving prophylactic stabilization of osteoporotic vertebral bodies at risk of fracture. However, there is concern that fat embolism and acute hypotension could occur as in a variety of other orthopedic procedures. METHODS:In six sheep, 6 mL of polymethylmethacrylate was injected unilaterally into L1. Transesophageal echocardiography monitored the pulmonary artery for echodense particles. Heart rate, arterial and venous pressures, and blood gas values were recorded before and for 25 minutes after injection. The lungs were subjected to postmortem histologic evaluation and compared with lung specimens from two sheep that had not undergone vertebroplasty. RESULTS:Injection of cement elicited a very rapid decrease in heart rate (within 2 +/- 1 seconds) and a rapid increase in venous pressure (within 3 +/- 1 seconds), which was followed by a fall in arterial pressure (within 5 +/- 2 seconds) (phase 1). Thereafter, showers of echogenic material appeared (within 6 +/- 1 seconds) and lasted for 138 +/- 36 seconds. A second more severe fall in arterial pressure was observed beginning at 18 +/- 2 seconds (phase 2). The injection resulted in an increase in partial pressure of carbon dioxide and a decrease in pH. The histology showed intravascular fat globules and bone marrow cells in lung tissue. CONCLUSIONS:The results suggest that immediately after cement injection, there was a reflex fall in heart rate and arterial pressure. The second fall in arterial pressure was a consequence of fat emboli passing through the heart and getting trapped in the lungs.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Aebli N,Krebs J,Davis G,Walton M,Williams MJ,Theis JC

doi

10.1097/00007632-200203010-00005

keywords:

subject

Has Abstract

pub_date

2002-03-01 00:00:00

pages

460-6

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

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Fat embolism and acute hypotension during vertebroplasty: an experimental study in sheep.