Cement Embolus Trapped in the Inferior Vena Cava Filter during Percutaneous Vertebroplasty
A 58-year-old female patient with a 1 year history of lung cancer was referred to our department for low back pain, left lower-limb swelling, cough and expectoration. Her low back pain was getting aggravated and the pain could not be controlled by analgesics. Computed tomography (CT) scan of spine revealed osteolytic metastatic lesion in the body of L4 without paravertebral space involvement. Ultrasound examination revealed free thrombus in the left iliac-femoral vein. To prevent pulmonary embolism (PE), a permanent IVC filter (OptEase™, Cordis, Roden, the Netherlands) was inserted in the IVC, before PVP was scheduled. The patient's coagulation function was normal. No anticoagulation or thrombolysis therapies were administered for the patient as the coming treatment.\nThe PVP procedure was performed under local anesthesia, by using a unilateral approach with a 13-gauge needle (Osteo-site, Cook, Bloomington, IN, USA), and it was guided by a digital subtraction angiography (DSA) fluoroscopy. When the needle tip reached the one third of the anterior L4 vertebral body, intraosseous venography was performed, which showed a rapid venous filling (): contrast material exited though the anterior external vertebral venous plexuses and emptied into the IVC. We repositioned the needle tip to avoid extravasation. However, venography findings were the same as before. The cement (CORIPLAST™ 3, Corin Medical, Gloucestershire, UK) was prepared by mixing a 2 g of sterile barium sulfate powder (Made by our hospital) for opacification, and was injected with a simple syringe during a paste-like viscosity. When the L4 vertebral body was nearly filled, fluoroscopy showed cement leaking into the IVC, and migrating to the filter (). The injection of the cement was interrupted immediately; a total of 5 mL bone cement had been injected. The patient was hemodynamically stable, and no cardiopulmonary function disturbances were noted.\nThe low-molecular-weight heparin was given subcutaneously for 3 days after the PVP procedure, and was replaced by warfarin later. After the procedure of PVP, the low back pain of the patient was obviously released. No evidence of PE or IVC perforation presented. The left lower-limb swelling of the patient was recovered 1 week later. She was discharged 10 days after PVP, and was followed-up at our outpatient department. There were no complications that occurred, which related to the filter, within the 8 months of follow-up.