CLINICAL-EXPERIENCE WITH THE GREENFIELD FILTER IN 193 PATIENTS AND DESCRIPTION OF A NEW TECHNIQUE FOR OPERATIVE INSERTION

Transvenous inferior vena cava (IVC) interruption using the Greenfield filter was performed upon 193 patients from January 1982 to December 1988. Placement of a filter in the TVC was indicated for prophylaxis ( 23.8 percent), contraindication to anticoagulation (22.8 percent), pul monary embolism despite anticoagulation (18.7 percent), complications of anticoagulation (26.9 percent) and free-floating thrombus (7.8 perc ent). Filters were placed in an infrarenal location in 92 percent of t he patients. The remaining 8 percent of patients had placement of a su prarenal filter for specific indications, without complication. Most ( 97.4 percent) of the patients had filters placed through internal jugu lar or femoral vein cutdown. Five patients required filter placement t hrough a retroperitoneal approach to the right common iliac vein and N C junction. This new technique of filter insertion is described. The o perative morbidity rate was 4.7 percent, with an additional 8.8 percen t having postoperative thrombotic complications. The 30 day operative mortality rate (6.7 percent) was related to preexisting associated dis ease. Nonfatal, late, recurrent pulmonary embolism occurred in 2.6 per cent of the patients despite filter placement. Caval patency remains a t 97.9 percent in long term follow-up evaluation. The Greenfield filte r is an effective and safe adjunct in the treatment of venous thromboe mbolic disease and a satisfactory prophylactic measure in specific hig h-risk patients.