Clinical experience with superior vena caval Greenfield filters

Purpose: To evaluate the results of superior vena caval (SVC) Greenfield fi lters in patients at risk for pulmonary embolism (PE) secondary to upper ex tremity deep venous thrombosis (UEDVT). Methods: Over a 46-month period, 26 patients (10 men, mean age 67 years, ra nge 25 to 89) with UEDVT in whom anticoagulation was contraindicated (n = 2 2) or ineffective in preventing recurrent PE or extension of the thrombus ( n = 4) were treated with placement of SVC Greenfield filters. Results: One SVC filter was misplaced into the innominate vein but left in place; this vein remains patent after 2 months without evidence of filter m igration. Follow-up ranged from 10 days to 46 months (mean 7.8 months). Fif teen (58%) patients died inhospital of causes unrelated to the SVC filter o r recurrent thromboembolism (mean time to death 36 days). Of the 11 survivo rs, follow-up ranged from 1 to 38 months (mean 22). Sequential chest roentg enograms in 9 (82%) patients revealed no filter migration or displacement. No evidence of PE was found in any of the survivors over the course of foll ow-up. Conclusions: Insertion of SVC Greenfield filters is a safe and feasible the rapy to prevent recurrent th romboembolism in patients with UEDVT who a re refractory to or inappropriate for anticoagulation therapy.