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[Cava filter for prevention of lung embolism: is implantation still justified?]
W Lang1, M Weingärtner, M Sturm
1Abteilung für Gefässchirurgie, Chirurgische Universitätsklinik Erlangen.
Insights
Greenfield vena caval filters were placed in 132 patients over 11 years. High complication rates suggest restricted use for pulmonary embolism and contraindications to anticoagulation.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiology
Background:
- Inferior Vena Cava (IVC) filters are used to prevent pulmonary embolism.
- Greenfield filters have been a treatment option for decades.
- Retrospective analysis of long-term outcomes is crucial for understanding filter utility.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of Greenfield vena caval filter placement.
- To identify the primary indications and complication rates associated with the filter.
- To provide evidence-based recommendations for filter utilization.
Main Methods:
- Retrospective review of 132 patients undergoing Greenfield filter placement over 11 years.
- Analysis of clinical records, including indications, procedural success, and complications.
- Follow-up included physical examination, abdominal X-ray, CT scans, or venacavography.
Main Results:
- Successful filter insertion in 117 patients (88.4%) with a 14.6% procedural failure rate.
- Major complications included recurrent pulmonary embolism (8%), caval thrombosis (13%), strut penetration (33%), tilting (25%), and migration (5%).
- A significant number of filters experienced tilting and strut penetration, raising safety concerns.
Conclusions:
- Greenfield filter placement has a high rate of complications, including strut penetration and tilting.
- Indications for filter placement should be carefully considered and restricted to specific cases.
- Filter use should be limited to situations where surgical or drug therapy has failed for pulmonary embolism or anticoagulation contraindications.
Abstract:
During a period of 11 years operative placement of a Greenfield vena caval filter was planned in 132 patients. The clinical records of these patients were reviewed retrospectively. Main indications for filter placement were pulmonary embolism in patients with deep venous thrombosis in spite of anticoagulation therapy (45%) and patients with contraindications for anticoagulation (40%). Insertion was successful in 117 patients with a failure rate of 14.6% (21 of 143 procedures). Follow-up data were obtained of all 117 patients with inserted filter (6 of them with 2 filters). Physical examination was performed in 67 of 74 patients alive after a mean postoperative period of 57 months (median: 52.5/range: 1-128). In addition, plain abdominal X-ray was available of all patients. CT scans of the abdomen or venacavography studies were obtained in 60 patients. Major complications as recurrent pulmonary embolism (8%), caval thrombosis (13%), penetrations of struts through the caval wall (33%), tilting of filters (25%), migration (5%) and filter fracture (two cases) were observed. In conclusion, indication should be restricted to certain cases with failure of surgical intervention or drug therapy (thrombectomy, lysis, anticoagulation).