Long-term follow-up of prophylactic greenfield filters in multisystem trauma patients
J Sekharan1, J W Dennis, F E Miranda
1Department of Surgery, University of Florida Health Science Center, Jacksonville, Florida 32209, USA.
Insights
Prophylactic Greenfield filters (PGFs) are safe and durable for high-risk trauma patients. Long-term follow-up shows no significant complications, establishing PGFs as a reliable intervention for preventing venous thromboembolism.
Area of Science:
- Trauma Surgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Venous thromboembolism (VTE) is a significant risk in multisystem trauma patients.
- Prophylactic Greenfield filter (PGF) placement is an established intervention for high-risk trauma patients.
- Long-term safety and durability data for PGFs in young, active trauma patients are crucial.
Purpose of the Study:
- To demonstrate the long-term safety and durability of prophylactic Greenfield filters (PGFs).
- To evaluate PGF performance in young, active trauma patients at high risk for VTE.
Main Methods:
- Prospective identification of trauma patients with ISS > 9 and specific injuries (head, spine, pelvic, long bone, iliofemoral venous) for PGF placement.
- Follow-up of patients with at least 5 years post-PGF placement using physical examination, duplex ultrasound, and radiography.
- Inclusion of four pre-protocol PGF cases for extended follow-up analysis.
Main Results:
- Of 108 eligible patients, 18 died (none from pulmonary embolism); autopsy data were available for 12.
- Follow-up was achieved in 33 of 94 eligible patients (35%) with a mean follow-up of 67.7 months.
- No filter migration or breakdown was observed on radiography; duplex ultrasound revealed no deep venous thrombosis, though six patients had mild edema.
Conclusions:
- Prophylactic Greenfield filters are safe and durable in high-risk trauma patients.
- Over 5 years of follow-up, PGFs showed no significant long-term adverse consequences.
- PGFs represent a reliable prophylactic measure against VTE in this patient population.
Purpose:
The efficacy of prophylactic Greenfield filter (PGF) placement in multisystem trauma patients at high risk for venous thromboembolism has been established. The objective of this study is to demonstrate the long-term safety and durability of PGFs placed in young, active trauma patients.
Methods:
Starting January 1992, all trauma patients at high risk for development of venous thromboembolism were identified for placement of PGFs. These included patients with ISS > 9 and severe closed head injury, spinal injury, pelvic fracture, multiple long bone fracture, or direct iliofemoral venous injury. Four patients with PGFs placed before the study protocol in 1992 were also included. Follow-up was attempted in all patients with at least 5 years' duration since placement of PGF using physical examination, duplex ultrasound (US), and plain abdominal radiograph.
Results:
There were 108 patients who had a PGF placement during the period of January 1992 to June 1994 that were eligible for the study. Eighteen of these 108 (17%) patients died. Twelve of them (67%) had autopsies and medical records available to determine the cause of death, none from a pulmonary embolism. The average time of death was 2.7 months after injury. The remaining 90 patients and the 4 patients with PGFs placed before 1992 were sought for follow-up, but only 36 patients could be contacted, 33 of which returned for evaluation (35%). The mean time of follow-up from the time of injury to the time of examination was 67.7 months, and the mean age at follow-up was 38.1 years. Although six patients had mild to moderate lower extremity edema on physical examination, none of them had a deep venous thrombosis by US. Radiographs obtained in 19 of the 33 patients showed no migration or breakdown of the Greenfield filters in place.
Conclusion:
Prophylactic Greenfield filters in high-risk trauma patients are safe and durable. There appears to be no significant consequence in over 5 years of follow-up.
