Recurrent pulmonary embolism after inferior vena caval interruption with a Greenfield filter

Twenty-six patients have undergone inferior vena caval interruption with a Greenfield filter. One patient (3.8%) developed a fatal, recurrent pulmonary embolism. Postmortem examination documented the presence of thrombus within the filter, proximal extension of thrombus beyond the filter apex, and fresh pulmonary emboli. In a combined series of 556 patients, 12 patients (2.2%) developed recurrent pulmonary emboli, 2 (0.36%) of which were fatal. Including case reports, 18 patients have had documented recurrent pulmonary emboli following Greenfield filter insertion. In 4 patients, the recurrent embolism was fatal. Six (60%) of 10 patients had a concomitant malignancy. A work-up and treatment plan for patients having recurrent pulmonary emboli after the insertion of a Greenfield vena caval filter is proposed.