The Greenfield Vena Cava Filter: 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 pooled reports of 463 attempted insertions from ten different series.- Of 463 attempts, 12 filters could not be placed due to technical or anatomic problems. Twenty-three filters were misplaced into locations, including the suprarenal IVC, renal vein, iliac veins, and the right ventricle. buy glucotrol online
Elimination of misplacements has been reported following adoption of routine guide wire usage. Thirty-three of208 filters were lodged obliquely in the cava, the denominator having been drawn from those series reporting this complication. Wound hematomata were noted in nine patients. Air emboli occurred in three patients without serious residua. Two episodes of vagal compression were noted by one series. A case report documented formation of clot within the carrier assembly (prior to constant heparin flush administration) with subsequent incomplete initial opening of the filter. Finally, one group reported perforation of the cava by three limbs of the filter after an attempt was made to push the filter more distally following release; however, no clinical problem ensued.
Early caval occlusion (at two weeks) has been reported in two patients. This was postulated to be due to massive embolic obstruction of the filter. There have been no other complications directly attributable to filter placement in the late postoperative period. Thirty day mortality varies from 0 to 14 percent. The deaths were uniformly related to the original embolic event or underlying disease. A single fatality due to early recurrence of pulmonary embolism has been reported following filter misplacement.