Intravascular embolization of bone cement during posterior lumbar interbody fusion (PLIF) is a well described complication.1, 2 Bone cement extruding into inferior vena cava (IVC) has been reported with variable outcomes including pulmonary embolization and cardiac rupture . Various management strategies are also reported including extraction of cement by open heart surgery (Lee, 2014). The objective of this report is to present the use of an endovascular stent to entrap the cement foreign body in the IVC to prevent cardiopulmonary embolization.

The author describes the case of a 77-year-old male with lumbar canal stenosis and degenerative scoliosis who underwent a PLIF surgery of the L3-S1 vertebra. The procedure was complicated by embolization of the bone cement material into the IVC. Subsequent imaging established two large pieces of the bone cement deposited in the IVC over the anterior vena cava wall, as well as evidence of minor pulmonary emboli of the same material into the right lung. Vascular surgical consult was sought a few days after the initial surgery. An angiogram of the vena cava was performed where a 30 × 40 mm (width × length) stent was deployed over the distal foreign body and a 30 × 40 mm and a 32 × 40 mm stent was placed over the larger proximal foreign body. After the minimally invasive endovascular treatment the patient made a rapid recovery. On a subsequent duplex ultrasound scan at 6 weeks and computed topography (CT) scan at 6 months post operatively, the stents remained patent and in good position and there was no evidence of embolization or migration of the foreign body.

This case highlights the use of endovascular stenting to entrap foreign bodies in the IVC as an acceptable solution to prevent cardiopulmonary embolization.