THE BIRDS NEST INFERIOR VENA-CAVAL FILTER - REVIEW OF A SINGLE-CENTEREXPERIENCE

PURPOSE: To examine a large single-center experience with Bird's Nest vena caval filters for indications, clinically evident recurrent throm boembolic disease, and other filter-related complications. MATERIALS A ND METHODS: During a 6-year period, 308 patients underwent percutaneou s placement of an inferior vena caval filter. The 267 patients who rec eived a Bird's Nest filter are the subject of this retrospective revie w, The series included 162 men and 105 women who ranged in age from 16 to 88 years (mean, 57.1 +/- 17.0 standard deviation). RESULTS: Indica tions for filter placement included contraindication to anticoagulatio n (n = 141), complication of anticoagulation (n = 23), failure of anti coagulation (n = 30), failure of previously placed filter (n = 1), and prophylaxis (n = 82), Ten patients had more than one indication, Acut e lower extremity deep venous thrombosis was confirmed in 133 patients , pulmonary embolism (PE) was found in 44 patients, and both were posi tively diagnosed in 37 other patients, Fifty-three patients had no doc umented acute thromboembolic disease at the time of insertion, Mean fo llow-up was 13 months, Thirty-day mortality was 9.7%, including one de ath from recurrent PE and one major puncture-site bleeding episode tha t may have contributed to death, Recurrent PE was found at radionuclid e scanning or autopsy in three patients (1.1%), whereas another eight patients (3.0%) had suspected recurrent PE without confirmatory studie s, Eight patients (3.0%) developed early venous access site thrombosis , including two who progressed to phlegmasia cerulea dolens with fatal complications, Significant nonthromboembolic problems were encountere d in 1.9% of patients. CONCLUSIONS: The Bird's Nest filter is a safe a nd effective device for patients with complicated venous thromboemboli c disease.