Impact of unilateral common iliac vein occlusion on trapping efficacy of the greenfield filter: An in vitro study

Rationale and Objectives. The purpose of this study was to assess the effec t of unilateral common iliac vein occlusion on the capturing efficacy of th e Greenfield filter in vitro. Materials and Methods. A stainless steel over-the-wire Greenfield filter wa s placed in the Silastic inferior vena cava module of a pulsatile circuit. Three 30-mm blood clots in sets of five were injected through the module's right iliac limb with the circuit in four experimental conditions: vertical position, both iliac limbs patent (VP): vertical position, left iliac limb occluded (VOC): horizontal position, both iliac limbs patent (HP): and hor izontal position, left iliac limb occluded (HOC). Each experiment was repea ted 15 times, resulting in 75 clots per condition and a total of 300 clot i ntroductions. Results. Clot trapping efficacy was 36 of 75 (48%) for VP, 41 of 75 (55%) f or VOC, 32 of 75 (43%) for HP, and 26 of 75 (35%) for HOC. Cross comparison s of the four conditions revealed a marginally significant difference (P = .0138 with a corrected test-wise alpha = .0125) only between horizontal and vertical positions with unilateral common iliac limb occlusion. Conclusion. Unilateral common iliac vein occlusion decreases the capturing efficacy of the Greenfield filter in the horizontal position in vitro. In p atients with unilateral common iliac vein occlusion, use of inferior vena c ava filters with higher capturing efficacy may be considered.