Complications encountered with the use of the Greenfield filter

Carabasi, R. Anthony; Moritz, Michael J.; Jarrell, Bruce E.

doi:10.1016/0002-9610(87)90171-1

Cited by 98 publications

(26 citation statements)

References 17 publications

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“…In most case reports found in the literature, pulmonary embolism, fatal or not, seems the most common complication to IVC filter thrombosis [18][19][20][21]. In the present study, pulmonary embolism was found in 33% of patients but was clinically suspected in only 20%.…”

Section: Discussionmentioning

confidence: 39%

Symptomatic inferior vena cava filter thrombosis: clinical study of 30 consecutive cases

Tardy¹,

Mismetti²,

Page³

et al. 1996

Eur Respir J

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S Sy ym mp pt to om ma at ti ic c i in nf fe er ri io or r v ve en na a c ca av va a f fi il lt te er r t th hr ro om mb bo os si is s: :c cl li in n--i ic ca al l s st tu ud dy y o of f 3 30 0 c co on ns se ec cu ut ti iv ve e c ca as se es s All patients had proximal venous thrombosis when the filter was placed, and the indication for filter placement was a contraindication to anticoagulant therapy in eight patients (27%). Filter thrombosis occurred within 6 months following filter placement in 15 patients (early filter thrombosis group). Among these patients, 10 were not treated with oral anticoagulant, and none of the other five received adjusted anticoagulation. No patients with late filter thrombosis received anticoagulant at the time of the diagnosis. Early filter thrombosis was mainly associated with LGM filters (12 of the 15 cases). Occlusion was revealed by recurrent venous thrombosis in 18 cases. A thrombus above the filter and pulmonary embolism was found in 10 patients (33%). Thrombolytic therapy failed in 5 out of 7 cases, and all but two patients were treated with anticoagulant therapy.In conclusion, early filter thrombosis appears to be due to intracaval extension of deep vein thrombosis, and this emphasizes the need for appropriate anticoagulation. In the case of temporary contraindication to anticoagulation at the time of the filter placement, anticoagulant should be reassessed later.

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Section: Discussionmentioning

confidence: 39%

Symptomatic inferior vena cava filter thrombosis: clinical study of 30 consecutive cases

Tardy¹,

Mismetti²,

Page³

et al. 1996

Eur Respir J

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“…The thrombogenicity of filters is no greater than that of exocaval clips, and their efficacy in preventing pulmonary embolism is identical. [5][6][7][8] Over time, the materials used for the fabrication of these filters have improved. Currently available filters are made of titanium.…”

Section: Discussionmentioning

confidence: 99%

“…9 Incorrect positioning of the filter followed by migration, whether distal or proximal, is one potential complication. 8 Accidental release of the filter has been described in the right renal vein, in the common iliac vein, in the suprarenal IVC, or even in the hepatic veins. [9][10][11] Retroperitoneal positioning with irritation of the genitofemoral nerve has been reported by Adye et al 11 In addition, lateral or posterior tilting may occur.…”

Section: Discussionmentioning

confidence: 99%

“…In certain instances migration of the filter toward the iliac vein has been treated simply by placing a second filter above the first. 8 Proximal migration is a much more serious occurrence. 12-21 A 0.9% incidence and an associated 0.6% mortality rate have been reported for the Mobin-Uddin filter.…”

Section: Discussionmentioning

confidence: 99%

“…Six cases of migration of the Kimray-Greenfield filter have been reported. 8,[12][13][14][15] In one case of intraventricular migration, no removal was attempted, whereas in five other cases of migration into the right atrium, the devices were removed (three surgically, one of which was under cardiopulmonary bypass, 15 one with the Greenfield apparatus, 23 and one by creating a lasso using suture material, which was passed around the filter 13 ). When the filter has migrated into the right atrium, it is theoretically possible to remove it without cardiopulmonary bypass, but the risk of injury to the coronary sinus or the tricuspid valve is high.…”

Section: Discussionmentioning

confidence: 99%

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Proximal Migration of Vena Caval Filters: Report of Two Cases With Operative Retrieval

Defraigne

Vahdat

Lacroix

et al. 1995

Annals of Vascular Surgery

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ABSTACTOperative retrieval of two proximaily migrated vena caval filters was performed in two patients, ages 42 and 45 years, respectively. In the first patient the filter was encrusted in the right ventricle, and in the second one the filter was found in the pulmonary artery. Both filters were retrieved under cardiopulmonary bypass via an incision in the right atrium and the pulmonary artery, respectively. These two observations underscore the risk of increased unwarranted indications and consequent higher complication rates of vena caval filters.Pulmonary embolism secondary to deep venous thrombosis (DVT) of the lower extremities or pelvis is a significant cause of morbidity and mortality. 1 Anticoagulation treatment is most often effective in preventing the lethal complications of DVT. Placement of a filter in the inferior vena cava (IVC) has been proposed for patients who have recurrent embolism despite adequate anticoagulation therapy or when there are contraindications to heparin. 2,3 Most of the currently available filters can be placed percutaneously in the IVC with no particular difficulty. Complications can arise, however, and may occasionally be severe. Two such severe complications of IVC filter placement are reported herein. CASE REPORTSCase 1. A 42-year-old man sustained a fracture of the right fibula, which was treated by a plaster cast at another hospital. Two weeks later he complained of pain in the right calf. After ablation of the plaster cast, phlebograms demonstrated thrombosis of the right sural and popliteal veins. The inferior vena cavogram was normal. No other clinical findings suggestive of pulmonary embolism, such as thoracic pain or acute dyspnea, were found. There were no contraindications to heparin therapy. In spite of this, the attending surgeon decided to place a vena caval filter via the right jugular vein. However, the filter (Filcard, Filcard International, Lille, France) did not open completely and migrated into the right heart. The patient was then referred to our unit.On admission, hemodynamic parameters were stable. Pulmonary x-ray examination (Fig. 1) showed that the filter was lodged in the right ventricle. Through a midline sternotomy and under cardiopulmonary bypass with induction of ventricular fibrillation, the right atrium was opened longitudinally. The filter was found to be entwined in the papillary muscles and the chordae tendineae of the right ventricle, with two of the hooks penetrating the right ventricular wall. Removal of the filter was difficult because the hooks at the end of each branch were oriented in different directions and the chordae tendineae had to be freed one at a time. After the filter was extracted, the right atrium was closed with a 4/0 continuous polypropylene suture.The postoperative course was complicated by severe bilateral bronchopneumonia that required prolonged intubation and tracheostomy. The patient was discharged 6 weeks later with no tricuspid insufficiency on followup echocardiography.Case 2. A 45-year-old man was admitted for sus...

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Inferior Vena Cava Filters

Becker¹

1992

Arch Intern Med

302

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Inferior vena cava filters appear to be effective in preventing recurrent pulmonary embolism. Despite the large published experience with IVC filters, many questions remain about their indications, safety, and effectiveness. Anticoagulant therapy, if not contraindicated, should be used in conjunction with filters. While there is no ideal filter, some situations call for specific filters. Filter selection and insertion require experience, modern angiographic technique, and collaboration between clinicians caring for patients and the interventional radiologists or surgeons inserting the device.

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Complications encountered with the use of the Greenfield filter

Cited by 98 publications

References 17 publications

Symptomatic inferior vena cava filter thrombosis: clinical study of 30 consecutive cases

Symptomatic inferior vena cava filter thrombosis: clinical study of 30 consecutive cases

Proximal Migration of Vena Caval Filters: Report of Two Cases With Operative Retrieval

Inferior Vena Cava Filters

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