Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters.
OBJECTIVE
Therapy to prevent pulmonary embolism (PE) resulting from upper extremity deep venous thrombosis (UEDVT) remains controversial despite an increasing incidence of DVT of upper extremity origin. The purpose of this study was to evaluate the results of 72 superior vena cava Greenfield filters (SVC-GFs) placed in patients at risk for PE arising from UEDVT.


METHODS
During the past 78 months, we placed SVC-GFs in 72 patients with UEDVT in whom anticoagulation was either deemed contraindicated (n = 67) or proved ineffective in preventing recurrent PE (n = 4) or extension of the thrombus (n = 1). There were 25 male (35%) and 47 (65%) female patients whose ages ranged from 25 to 99 years (mean, 74 years). Follow-up ranged from 10 days to 78 months (mean, 7.8 months). Sequential chest radiographs revealed no filter migration or displacement in 26 patients.


RESULTS
Thirty-four patients died in the hospital of causes unrelated to the SVC filter or recurrent thromboembolism (mean time to death, 20 days). Follow-up of the surviving 38 patients ranged from 1 month to 78 months (mean, 22 months); none of these patients were seen with any evidence of PE. One SVC-GF was incorrectly discharged into the innominate vein and left in place. This vein remains patent 2 months after insertion without evidence of filter migration.


CONCLUSIONS
We think that insertion of SVC-GFs is a safe, efficacious, and feasible therapy and may prevent recurrent thromboembolism in patients with UEDVT who are resistant to anticoagulation or have contraindications to anticoagulation.
Ascher
E
E
Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Hingorani
A
A
Tsemekhin
B
B
Yorkovich
W
W
Gunduz
Y
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D002404:Catheterization / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency; D016306:Vena Cava Filters; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*