JOURNAL OF VASCULAR SURGERY December 2013
1744 Letters to the Editor
4. Grant SW, Grayson AD, Purkayastha D, Wilson SD, McCollum C; on behalf of the participants in the Vascular Governance North West P. Logistic risk model for mortality following elective abdominal aortic aneurysm repair. Br J Surg 2011;98:652-8. 5. Hickey GL, Grant SW, Murphy GJ, Bhabra M, Pagano D, McAllister K, et al. Dynamic trends in cardiac surgery: why the logistic euroscore is no longer suitable for contemporary cardiac surgery and implications for future risk models. Eur J Cardio Thorac Surg 2013;43:1146-52.
or anterior tibial artery or even the dorsalis pedis or pedal arteries for either removal of cement or a distal bypass. In any case, these two case reports show that peripheral arterial embolization of cement should not be considered as an exotic complication but as a possibility that a vascular surgeon should be aware of, given the increasing use of cement in orthopedic procedures.
http://dx.doi.org/10.1016/j.jvs.2013.08.088
Department of Vascular Surgery Athens University Medical School “Attikon” Hospital Athens, Greece
Regarding “Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty” We have read with keen interest the paper by Mozaffar et al on “Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty.”1 The authors state that this is the first report of intra-arterial embolization of cement. In 2009, however, we had published a case report of peripheral arterial embolization of cement during revision spine surgery.2 Whereas the case presented by Mozaffar et al differs in terms of the material used (polymethylmethacrylate instead of bisphenol-a-glycidyldimethacrylate-based cortical bone void filler) and the type of operation (percutaneous vertebroplasty instead of revision spine surgery), the mechanism and the complication itself, from the vascular surgery standpoint, is exactly the same (intra-arterial injection of cement with peripheral embolization). An important conclusion that can be drawn from these two papers is that Fogarty embolectomy from a proximal artery (common femoral or popliteal artery) is fated to fail and that the only possible bailout procedure is the exploration of the posterior
John D. Kakisis, MD
Konstantinos Soultanis, MD First Department of Orthopedics Athens University Medical School “Attikon” Hospital Athens, Greece REFERENCES 1. Mozaffar M, Radpay MR, Zirakzadeh H, Nabavizadeh P, Sobhiye MR, Langroudi RM. Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty. J Vasc Surg 2012;56:1107-9. 2. Soultanis K, Kakisis JD, Pyrovolou N, Lazaris AM, Vasdekis S, Soukakos P. Peripheral arterial embolization of cement during revision spine surgery. Ann Vasc Surg 2009;23:413.e9-12. http://dx.doi.org/10.1016/j.jvs.2012.10.142
1744 Letters to the Editor
4. Grant SW, Grayson AD, Purkayastha D, Wilson SD, McCollum C; on behalf of the participants in the Vascular Governance North West P. Logistic risk model for mortality following elective abdominal aortic aneurysm repair. Br J Surg 2011;98:652-8. 5. Hickey GL, Grant SW, Murphy GJ, Bhabra M, Pagano D, McAllister K, et al. Dynamic trends in cardiac surgery: why the logistic euroscore is no longer suitable for contemporary cardiac surgery and implications for future risk models. Eur J Cardio Thorac Surg 2013;43:1146-52.
or anterior tibial artery or even the dorsalis pedis or pedal arteries for either removal of cement or a distal bypass. In any case, these two case reports show that peripheral arterial embolization of cement should not be considered as an exotic complication but as a possibility that a vascular surgeon should be aware of, given the increasing use of cement in orthopedic procedures.
http://dx.doi.org/10.1016/j.jvs.2013.08.088
Department of Vascular Surgery Athens University Medical School “Attikon” Hospital Athens, Greece
Regarding “Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty” We have read with keen interest the paper by Mozaffar et al on “Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty.”1 The authors state that this is the first report of intra-arterial embolization of cement. In 2009, however, we had published a case report of peripheral arterial embolization of cement during revision spine surgery.2 Whereas the case presented by Mozaffar et al differs in terms of the material used (polymethylmethacrylate instead of bisphenol-a-glycidyldimethacrylate-based cortical bone void filler) and the type of operation (percutaneous vertebroplasty instead of revision spine surgery), the mechanism and the complication itself, from the vascular surgery standpoint, is exactly the same (intra-arterial injection of cement with peripheral embolization). An important conclusion that can be drawn from these two papers is that Fogarty embolectomy from a proximal artery (common femoral or popliteal artery) is fated to fail and that the only possible bailout procedure is the exploration of the posterior
John D. Kakisis, MD
Konstantinos Soultanis, MD First Department of Orthopedics Athens University Medical School “Attikon” Hospital Athens, Greece REFERENCES 1. Mozaffar M, Radpay MR, Zirakzadeh H, Nabavizadeh P, Sobhiye MR, Langroudi RM. Intra-arterial injection of acrylic cement as a complication of percutaneous vertebroplasty. J Vasc Surg 2012;56:1107-9. 2. Soultanis K, Kakisis JD, Pyrovolou N, Lazaris AM, Vasdekis S, Soukakos P. Peripheral arterial embolization of cement during revision spine surgery. Ann Vasc Surg 2009;23:413.e9-12. http://dx.doi.org/10.1016/j.jvs.2012.10.142
