Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters

Purpose: Therapy to prevent pulmonary embolism (PE) resulting from upper ex tremity deep venous thrombosis (UEDVT) remains controversial despite an inc reasing incidence of DVT of upper extremity origin. The purpose of this stu dy 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 UE DVT in whom anticoagulation was either deemed contraindicated (n = 67) or p roved ineffective in preventing recurrent PE (n = 4) or extension of the th rombus (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 reveale d no filter migration or displacement in 26 patients. Results: Thirty-four patients died in the hospital of causes unrelated to t he SVC filter or recurrent thromboembolism (mean time to death, 20 days). F ollow-up of the surviving 38 patients ranged from 1 month to 78 months (mea n, 22 months); none of these patients were seen with ally evidence of PE. O ne SVC-GF was incorrectly discharged into the innominate vein and left in p lace. 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 wit h UEDVT who are resistant to anticoagulation or have contraindications to a nticoagulation.