Category: Vena Cava

The Greenfield Vena Cava Filter: Indications and Discussion

Indications and Discussion No technique can be evaluated without establishing an “ideal” standard. In our view, such an ideal caval interruptive approach would incorporate the following features: (1) The procedure should be applicable with safety and efficacy by physicians of reasonable skill after modest periods of training. (2) The procedure should be performed without general…

The Greenfield Vena Cava Filter: Caval Perforation

The Greenfield Vena Cava Filter: Caval Perforation

Caval Perforation As stated previously, when the filter springs open during insertion, its struts engage the wall of the vena cava with some force. Penetration of the caval wall by the sharp anchoring prongs is necessary to prevent filter migration. Whether the prongs actually perforate the cava is not documented, but there have been no…

The Greenfield Vena Cava Filter: Anticoagulation

Anticoagulation Anticoagulation remains the primary therapy for deep venous thrombosis. Caval filtration serves to protect the patient from one complication of this disease (pulmonary embolism) but has no effect on venous thrombosis. Therefore, anticoagulation should be administered as usual if no contraindication exists. While he prefers to discontinue heparinization briefly prior to insertion, Greenfield contends…

The Greenfield Vena Cava Filter: Recurrent Pulmonary Embolism

The Greenfield Vena Cava Filter: Recurrent Pulmonary Embolism

Recurrent Pulmonary Embolism The purpose of caval filtration is to prevent pulmonary embolism. One of the arguments against the use of the Mobin-Uddin umbrella, and indeed, all other devices which can lead to caval occlusion, is that future embolization may take pace through extensive venous collateral circulation. In addition, the presence of a foreign surface…

The Greenfield Vena Cava Filter: Operative Complication

Operative Complication Most series documenting operative complications were compiled prior to the changes made in 1983, changes designed to improve certain reported complications of insertion: oblique placement, clot formation during insertion, and difficult accurate placement into the infrarenal IVC. Anecdotal reports substantiate these improvements. Therefore, these early reports likely represent “worse case” scenarios. We have…

The Greenfield Vena Cava Filter: Operative Technique

The Greenfield Vena Cava Filter: Operative Technique

Operative Technique Anatomic definition of a patients IVC is mandatory prior to filter placement, as the device has a finite maximal diameter. In addition to congenital abnormalities in the venous system, cavae with diameters greater than 28 mm (so-called “megacavae”) may be encountered. Indeed, the one report of significant proximal filter migration was due to…

The Greenfield Vena Cava Filter: Mobin-Uddin Filter

Figure 1. The Greenfield filter (metric measure).

Mobin-Uddin Filter In order to appreciate the development of the Greenfield filter, it is necessary to understand what has previously been available. The Mobin-Uddin filter was the first widely used transvenous device, having been introduced in the 1960s. It resembles an umbrella and consists of six stainless steel spokes radiating from a central hub. A…

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