Experience with the Gianturco-Roehm Bird's Nest vena cava filter

Abstract

Mechanical interruption of the inferior vena cava protects patients with lower extremity deep venous thrombosis from pulmonary embolism. It is the procedure of choice for patients who either cannot be anticoagulated, or have had recurrent pulmonary embolism despite anticoagulation. Extensive experience with the Greenfield vena cava filter (Medi-tech Inc., Watertown, Massachusetts) has shown long-term caval patency rates of >95%, and rates of recurrent pulmonary embolism of <5%. 1 However, a malposition rate as high as 14%, 2,3 premature filter release, 4 perforation of the inferior vena cava and associated structures, 5 and femoral vein thrombosis at the site of insertion 6 remain potential problems. The Gianturco-Roehm Bird's Nest Filter (Cook Inc., Bloomington, Indiana), approved for clinical use by the Food and Drug Administration in 1989, was designed to overcome some of the disadvantages of the Greenfield filter. Designed for percutaneous introduction through the jugular, subclavian and femoral approaches, it consists of 2 rigid, V-shaped struts, between which are attached four 25-cm-long, 0.18-mm diameter stainless steel wires (Figure 1). Properly positioned, the fine wire mesh filter occupies a 6- to 7-cm length of inferior vena cava (Figure 2).