Long-term follow-up of Greenfield inferior vena cava filter placement in children

Objective: The long-term results of Greenfield inferior vena cava (IVC) fil ter placement have been well documented in adults; however, similar data do not exist for pediatric patients. The potential for growth and the increas ed life expectancy in younger patients may contribute to a difference in th e natural history of filters placed in children. The objective of this stud y was to evaluate the long-term outcome of pediatric patients with IVC filt ers. Methods. At the University of Massachusetts Memorial Medical Center, medica l records and radiographs of patients 18 years old or younger at the time o f IVC filter placement were reviewed. Follow-up data were obtained by inter view, physical examination, and venous duplex ultrasound scanning. Results. A total of 15 IVC filters were placed in children 18 years old or younger between 1983 and 1999. In 10 patients the indications for IVC filte r placement were lower-extremity deep venous thrombosis (DVT) and/or pulmon ary embolism. In five patients, prophylactic filters were placed in die abs ence of DVT because of a high risk for the development of pulmonary embolis m. Surgical exposure of the right internal jugular vein was used to place t he first eight filters. The remainder were inserted percutaneously through the right internal jugular vein or the right common femoral vein. There wer e no complications or mortality related to filter insertion. Follow-up of t he surviving 14 patients ranged from 19 months to 16 years. During long-ter m follow-up, no patient had a pulmonary embolus. Of the nine patients who h ad lower-extremity DVT, three developed mild common femoral venous reflux d ocumented by duplex scan. Of the five patients who had prophylactic filters , four had no symptoms or duplex evidence of reflux. The other patient, who was paraplegic, had bilateral leg edema but no venous varicosities mid no reflux on duplex scan 11 years after filter placement. No patient in either group had chronic venous obstruction, Conclusion: In long-term follow-up there were no instances of pulmonary emb olism, IVC thrombosis, significant postphlebitic symptoms, or significant f ilter migration among 14 pediatric patients with Greenfield IVC filters. Th is suggests a safety profile and efficacy similar to that seen in adults.