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Prophylactic placement of vena caval filters: a cautionary note
B S Greene1, G Hellwarth, W K Rundell
1Department of Surgery, USAF Medical Center, Wright-Patterson AFB, Dayton, Ohio 45433.
Annals of Vascular Surgery
|May 1, 1990
Summary
Greenfield filter placement in high-risk patients without deep venous thrombosis showed low morbidity and no mortality. However, its widespread prophylactic use is costly and lacks proven superior efficacy compared to other methods.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Medical Device Safety
Background:
- Greenfield filters are used for pulmonary embolism (PE) prophylaxis in high-risk patients.
- Placement without documented deep venous thrombosis (DVT) is termed 'truly prophylactic'.
- Community hospital data on this practice is limited.
Purpose of the Study:
- To evaluate the safety, efficacy, and cost of Greenfield filter placement in patients without DVT.
- To assess outcomes in a community hospital setting.
- To inform clinical practice regarding prophylactic filter use.
Main Methods:
- Retrospective review of 59 Greenfield filter placements in 58 patients across five community hospitals over three years.
- Analysis of placement methods (surgical vs. percutaneous) and associated costs.
- Review of indications and observed morbidity/mortality.
Main Results:
- 90% of filters were placed surgically at an average cost of $4,141.00 per procedure.
- Low morbidity and no mortality directly related to filter placement were observed.
- Efficacy and safety comparable to large institutions were noted, despite infrequent operator experience.
Conclusions:
- Greenfield filter placement in community hospitals demonstrates safety and efficacy similar to major centers.
- Prophylactic use in patients without DVT is costly and carries patient risks.
- Widespread use for PE prophylaxis in DVT-negative patients is cautioned against pending evidence of superior efficacy over alternative methods.