Related Experiment Videos
Late results of suprarenal Greenfield vena cava filter placement
L J Greenfield1, K J Cho, M C Proctor
1Department of Surgery, University of Michigan, Ann Arbor.
Insights
Suprarenal Greenfield filter placement is safe and effective for patients with renal vein thrombus or those who are pregnant. This study found no filter obstruction or renal dysfunction in long-term follow-up.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Inferior Vena Cava (IVC) filters are used to prevent pulmonary embolism.
- Suprarenal placement of IVC filters is sometimes necessary for specific patient populations.
- Limited data exists on the long-term safety and efficacy of suprarenal IVC filter placement.
Purpose of the Study:
- To evaluate the safety and efficacy of suprarenal Greenfield filter placement.
- To assess long-term outcomes including filter patency, recurrent embolism, and complications.
Main Methods:
- Retrospective review of Greenfield filter placement in two institutional registries.
- Analysis of 71 patients requiring suprarenal filter placement.
- Follow-up data collection including clinical status, imaging, and mortality.
Main Results:
- Recurrent embolism rate was 4%, similar to infrarenal placement.
- All evaluated filters (22 patients) remained patent with no evidence of obstruction.
- No renal dysfunction or significant clinical sequelae from filter migration/fracture were observed.
Conclusions:
- Suprarenal Greenfield filter placement is a safe and effective option for patients with thrombus extending to or within the renal veins.
- It is also suitable for pregnant patients or women of childbearing age.
- Long-term follow-up demonstrates sustained patency and minimal complications.
Abstract:
Placement of the Greenfield filter above the renal veins was necessary in 71 (9%) of 821 total patients in the filter registries of two institutions. The status of 60 patients (85%) could be verified, with follow-up data ranging from 18 months to 16 years (average, 53 months). Of 24 deaths (34%), none was from recurrent embolism or renal failure; death was most commonly associated with a malignant neoplasm. The recurrent embolism rate was 4%, identical to the infrarenal experience. Duplex evaluation of the filters in 22 patients, representing the majority (61%) of living patients, showed that all the filters were patent. Sixteen patients (41%) had lower-extremity edema that predated filter insertion, and in no patient did the results of noninvasive venous studies worsen. Filter fracture (two patients) or distal migration (two patients) had no clinical sequelae, and there was no evidence of renal dysfunction. For thrombus extending to the level of the renal veins or within them and for pregnant patients or women of childbearing age, suprarenal placement of the Greenfield filter is safe and effective, with no filter obstruction seen in follow-up extending to 16 years.