Header

UZH-Logo

Maintenance Infos

Influence of bone marrow fat embolism on coagulation activation in an ovine model of vertebroplasty


Krebs, J; Ferguson, S J; Hoerstrup, S P; Goss, B G; Haeberli, A; Aebli, N (2008). Influence of bone marrow fat embolism on coagulation activation in an ovine model of vertebroplasty. Journal of Bone and Joint Surgery. American Volume, 90(2):349-356.

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.

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.

Statistics

Citations

Dimensions.ai Metrics
21 citations in Web of Science®
22 citations in Scopus®
24 citations in Microsoft Academic
Google Scholar™

Altmetrics

Downloads

186 downloads since deposited on 12 Feb 2009
24 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Division of Surgical Research
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:February 2008
Deposited On:12 Feb 2009 15:05
Last Modified:18 Feb 2018 10:47
Publisher:Boston, Journal of Bone and Joint Surgery
ISSN:0021-9355
OA Status:Green
Publisher DOI:https://doi.org/10.2106/JBJS.G.00058
PubMed ID:18245595

Download

Download PDF  'Influence of bone marrow fat embolism on coagulation activation in an ovine model of vertebroplasty'.
Preview
Filetype: PDF
Size: 2MB
View at publisher