Günther vena caval filter: clinical appraisal

The mechanical stability of the Günther filter, caval patency, and complications related to filter placement were evaluated in 33 patients. Indications for placement included recurrent pulmonary embolism despite anticoagulation (n = 24) and contraindication to anticoagulation (n = 5). Four filters were placed prior to pulmonary lysis. Filters were positioned via the transfemoral route in 31 patients and via the transjugular route in two. Placement was complicated by pneumothorax in one case and faulty filter position in another. Patients were followed up for 52 months (mean, 12.1 months). Four patients died of nonembolic complications; three patients were lost to follow-up. Among the remaining 26 patients, caudal migration (3-6 cm) occurred in 19 (73%), cephalic migration into the atrium occurred in one, the inferior vena cava occluded in five, and struts perforated the caval wall in five. Pulmonary embolism recurred in one patient. In 11 cases, thrombus caught inside the basket was revealed with computed tomography; in one case a 7-cm floating thrombus was observed. The authors conclude that use of the Günther filter cannot be recommended because of the high prevalence of complications.