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Suprarenal placement of vena caval filters: indications, techniques, and results
Insights
Suprarenal Greenfield filters effectively treat thromboembolism when standard infrarenal inferior vena cava (IVC) interruption is inadequate. This study shows no recurrent pulmonary emboli in patients with complex IVC thrombi, demonstrating suprarenal filter safety and efficacy.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Infrarenal inferior vena cava (IVC) interruption is standard for thromboembolism when heparin fails or is contraindicated.
- Routine infrarenal IVC interruption may be inadequate for complex thrombus extending above renal veins.
Purpose of the Study:
- To evaluate the efficacy and safety of suprarenal Greenfield filter placement in patients with complex IVC thrombi.
- To determine indications for suprarenal filter placement in challenging thromboembolism cases.
Main Methods:
- Suprarenal Greenfield filters were placed in 11 patients with complex IVC thrombi.
- Patient data including IVC venography, renal function, and clinical outcomes were analyzed.
- Follow-up ranged from 3 to 26 months.
Main Results:
- No recurrent pulmonary emboli (PE) were documented in any patient during follow-up.
- No changes in renal function or development of peripheral edema were observed.
- Inferior vena cava (IVC) patency was maintained in all patients; 8 patients continued anticoagulation.
Conclusions:
- Suprarenal filter placement is indicated for recurrent thromboemboli with IVC thrombi extending above renal veins, renal vein thrombosis, or large ovarian vein thrombi.
- It is also effective for perirenal IVC thrombi when anticoagulation is contraindicated.
- Suprarenal IVC filter placement is an effective therapy for thromboemboli originating at or above the renal veins.
Abstract:
Preferred treatment for thromboembolism when heparin fails or is contraindicated is infrarenal inferior vena cava (IVC) interruption. In the present study suprarenal Greenfield filters were placed in 11 patients in whom routine infrarenal IVC interruption would have been inadequate therapy. As identified by IVC venography, nine patients, including two patients with renal vein thrombi and proteinuria, had partially attached IVC thrombi extending to or above the orifices of the renal veins. One patient had multiple life-threatening pulmonary emboli (PE) on anticoagulation therapy without a known source of emboli and a large patent ovarian vein, and another had an ovarian vein thrombus. Five patients (45%) had a contraindication to heparin therapy, and five (45%) had recurrent PE on anticoagulants. In follow-up (range 3 to 26 months, mean 12.3 months) there has been no documented or suspected recurrent PE, change in renal function, or peripheral edema. There were two deaths secondary to malignancy. IVC patency was demonstrated in all patients studied. Eight patients continue to receive anticoagulants. Based on our clinical experience, our data suggest that suprarenal filter placement is indicated in the following situations: (1) recurrent thromboemboli despite anticoagulation therapy with IVC thrombi extending to or above the renal veins, renal vein thrombosis, previous IVC interruption, or a large patent left ovarian vein or (2) documented perirenal IVC thrombi when anticoagulation therapy is contraindicated. The results of this study indicate that when thromboemboli originate at or above the level of the renal veins in the IVC, suprarenal IVC filter placement is effective therapy.