Greenfield Vena Cava Filter Research Articles

肺塞栓を合併した左被殻出血のリハビリテーション 症例報告

Pulmonary embolism and deep vein thrombosis are believed to be rare in Japan, whereas, they are an important cause of death in stroke patients in Europe or United States. However, a few studies have warned that incidences of them are underestimated in Japan. A 57-year-old woman with acute putaminal hemorrhage admitted to our hospital 11 days after stroke, and intensive rehabilitation program was applicated. Before her admission to our hospital, she was admitted to another hospital and forced to have complete rest. She presented symptoms of hypoxia 19 days after stroke. She was diagnosed as having pulmonary embolism. Clinical findings of pain or swelling of the paralized leg were absent. Greenfield vena cava filter was implanted immediately after diagnosis, and mild anticoagulant therapy was also started. Physical therapy was practiced with the supply of oxigen under the cardiac, hemodynamometric and oximetric monitoring. These special consideration enabled her to be applied physical therapy more safely. When she was discharged home at 38 days after stroke, her activities of daily living had already improved to be independent. We consider that physical therapy including standing is good indication for acute stroke patients to prevent deep vein thrombosis or pulmonary embolism.

Accidental Intraaortic Placement of a Greenfield Filter

A Greenfield vena cava filter was accidentally placed in the mid-abdominal aorta. It was manipulated to the aortic bifurcation, where it has been observed for >48 months. This case is the first example of arterial placement of a vena cava filter. This report describes the probable mechanisms for this aberrant placement, methods for prevention of this complication, and options for management of this problem.

In vitro function of an adjustable temporary venous spring filter: Comparison with the temporary RF02 filter and the permanent greenfield vena cava filter

The authors compared in vitro function of a temporary venous spring filter with that of a temporary RF02 filter and a permanent Greenfield filter. All three types of filters were placed in thin polyethylene tubes (diameters, 10.0-18.0 mm). Physiologic saline was substituted for flowing blood, and blood clots of three sizes (6 x 10 mm, 6 x 20 mm, 9 x 20 mm) were funneled to the filters. Clot-trapping ability of each filter and elevation of intraluminal pressure after clot trapping were assessed for each tube size. No statistically significant elevation in intraluminal pressure was detected immediately after placement of any filter. The clot-trapping ability of the spring filter and of Greenfield filter were slightly lower than that of the RF02 filter, but the differences were not statistically significant. After filters had trapped large clots, a high pressure gradient was detected in the 10.0-mm tube for all filters. The spring filter was associated with a higher pressure than the other filters in the 12.0-mm tube (P < .05). In vitro function of the spring filter was satisfactory in comparison with that of the RF02 filter and the Greenfield filter. For efficient filtering in the inferior vena cava, development of a larger version of the filter may be necessary.

Clinical results of Greenfield filter use in patients with cancer

The purpose of this report is to examine the outcomes for patients with an underlying diagnosis of malignancy who have had Greenfield vena caval filters placed for protection from pulmonary embolism, and to identify areas requiring further study. This was a retrospective review of data obtained from the Greenfield filter registry and the University of Michigan Tumor Registry for 166 patients treated at the University of Michigan Medical Center between January 1988 and June 1994. The 84 men and 82 women (mean age 57.8 years) had a mean survival time of 10 (range 1–68) months. This differs significantly from patients in the filter registry who do not have malignancy ( P<0.0001). Some 51% experienced recurrence of their malignancy at a mean of 20 months; this timing corresponds to development of new or recurrent thrombembolism and filter placement. Distant metastases were present in 72% of patients at the time of filter placement. In conclusion, as anticipated, filter patients with malignancy have a significantly shorter survival time than those with other concurrent diseases. A temporal association between the progression of the malignancy and the occurrence of thromboembolism is observed in this population and requires further study. Future studies regarding the use of vena caval filters in these patients and the role of diagnostic screening for deep venous thrombosis and occult recurrence of malignancy should focus on efficacy, safety, cost and patient quality of life rather than on survival. © 1997 The International Society for Cardiovascular Surgery.

Clinical Results of Greenfield Filter Use in Patients with Cancer

The purpose of this report is to examine the outcomes for patients with an underlying diagnosis of malignancy who have had Greenfield vena caval filters placed for protection from pulmonary embolism, and to identify areas requiring further study. This was a retrospective review of data obtained from the Greenfield filter registry and the Univeristy of Michigan Tumor Registry for 166 patients treated at the University of Michigan Medical Center between January 1988 and June 1994. The 84 men and 82 women (mean age 57.8 years) had a mean survival time of 10 (range 1–68) months. This differs significantly from patients in the filter registry who do not have malignancy ( P&lt;0.0001). Some 51% experienced recurrence of their malignancy at a mean of 20 months; this timing corresponds to development of new or recurrent thrombembolism and filter placement. Distant metastases were present in 72% of patients at the time of filter placement. In conclusion, as anticipated, filter patients with malignancy have a significantly shorter survival time than those with other concurrent diseases. A temporal association between the progression of the malignancy and the occurrence of thromboembolism is observed in this population and requires further study. Future studies regarding the use of vena caval filters in these patients and the role of diagnostic screening for deep venous thrombosis and occult recurrence of malignancy should focus on efficacy, safety, cost and patient quality of life rather than on survival.

Intracardiac and intrapulmonary Greenfield filters: A long-term follow-up

The Greenfield vena caval filter has become the preferred method of vena caval filtration. Its high long-term patency rate and low complication rate make it ideal for those patients in whom anticoagulation has failed or is contraindicated. A known complication of filter insertion is the inadvertent placement or migration of the filter to the right side of the heart. We present three cases from our institution where the Greenfield filter was inadvertently ejected into the right atrium. An attempt at removal with a wire loop and sheath in two cases failed and resulted in the migration of one filter to the right inferior pulmonary artery. We found no evidence of long-term complications at 2, 45, and 60 months. We conclude that conservative management may be considered in these cases.

Intracardiac and intrapulmonary Greenfield filters: A long-term follow-up

The Greenfield vena caval filter has become the preferred method of vena caval filtration. Its high long-term patency rate and low complication rate make it ideal for those patients in whom anticoagulation has failed or is contraindicated. A known complication of filter insertion is the inadvertent placement or migration of the filter to the right side of the heart. We present three cases from our institution where the Greenfield filter was inadvertently ejected into the right atrium. An attempt at removal with a wire loop and sheath in two cases failed and resulted in the migration of one filter to the right inferior pulmonary artery. We found no evidence of long-term complications at 2, 45, and 60 months. We conclude that conservative management may be considered in these cases.

Prophylactic and early therapeutic use of the greenfield filter in hip and knee joint arthroplasty

The orthopaedic literature does not provide clear guidelines for the protection of the extremely high-risk thromboembolic patient undergoing hip and knee total joint or related reconstructive surgery. Nor is there agreement of how to protect the immediate postoperative patient with thromboembolic complications. The authors, believing that routine anticoagulation measures are ill-advised in these two circumstances, elected instead to place a Greenfield vena cava filter for prevention of life-threatening thromboembolism. Using prospec- tive selection criteria, 47 patients could be followed over a 24–76-month period. There were no clinical embolic episodes in either group and no late complications of the filter placement. The few complications in this series were related to insertion, only one of which lead to minor long-term disability. The caval patency rate was 96%. The authors have concluded that such prophylactic use of the Greenfield vena cava filter is justified since it contributes to safer and more reliable total hip and total knee surgery with only minor morbidity.

Monorail system for percutaneous repositioning of the Greenfield vena cava filter.

HomeRadiologyVol. 179, No. 3 PreviousNext LettersMonorail system for percutaneous repositioning of the Greenfield vena cava filter.T V Myers, F Y Tsai, M E MyersT V Myers, F Y Tsai, M E MyersT V MyersF Y TsaiM E MyersPublished Online:Jun 1 1991https://doi.org/10.1148/radiology.179.3.2028015MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1991 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 179, No. 3 Metrics Altmetric Score PDF download

Recurrent pulmonary embolism in pregnancy managed with the Greenfield vena caval filter

Recurrent embolisation from venous thrombosis despite anticoagulation, in pregnancy, constitutes a major diagnostic and management problem. We present just such a patient who was managed with a Greenfield vena caval filter, which enabled her pregnancy to continue, resulting in a vaginal delivery of a healthy female infant at 38 weeks gestation.

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

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).

Monorail system for percutaneous repositioning of the Greenfield vena caval filter.

The authors describe a technique for removing or repositioning a malpositioned Greenfield inferior vena caval filter. A "monorail" system was used, in which a wire was passed from the femoral vein through the apical hole in the filter and out the internal jugular vein; the wire was held taut from above and below and thus facilitated repositioning or removal of the filter. The technique was used successfully in two cases.

Spontaneous disruption of two Greenfield vena caval filters.

Two cases of fractured Kimray-Greenfield vena caval filter struts in patients with pulmonary embolism are reported. Both filters were inserted without complications by means of a jugular approach. Postoperative radiographs demonstrated correct positioning of the filter. During the follow-up period in both cases the devices migrated caudally and penetrated the caval wall; however, the patients remained asymptomatic. Radiographs should be obtained in the follow-up period to ensure proper positioning of the vena caval filter even in asymptomatic patients.

Thrombus-trapping efficiency of the Greenfield filter in vivo.

A total of 100 radiopaque blood clots were injected into seven adult sheep under fluoroscopic observation to assess the clot-trapping efficiency of the Greenfield vena caval filter. Eleven percent of the clots passed through the filter, with all failures limited to the two smallest clot sizes: 4 x 10 mm (five of 25) and 4 x 30 mm (six of 25). The Greenfield filter was 100% efficient in trapping larger clots (8 x 10 mm and 8 x 30 mm). There was a tendency toward poorer clot-trapping performance when the Greenfield filter was tilted within the vena cava, but this was not significant. There were no significant differences in hemodynamic measurements obtained immediately before and after injection of each clot, and no significant changes were noted in the animal's hemodynamic status or in blood gas measurements in those cases in which the clots passed through the filter. Since the caval diameter in sheep approximates that in humans, the authors conclude that the Greenfield filter in the clinical setting is capable of stopping large, likely fatal, emboli and a large number of smaller, possibly less clinically significant, emboli.

Small-bowel obstruction by adhesions secondary to caval perforation by Greenfield vena cava filter

Small-bowel obstruction by adhesions secondary to caval perforation by Greenfield vena cava filter

Small-bowel obstruction by adhesions secondary to caval perforation by Greenfield vena cava filter.

Small-bowel obstruction by adhesions secondary to caval perforation by Greenfield vena cava filter.

Surgical management of heparin-associated thrombocytopenia: Strategies in the treatment of venous and arterial thromboembolism

We report the vascular surgical strategies and results in 13 patients with heparin-associated thrombocytopenia and describe useful in vitro techniques for the evaluation of anticoagulant therapy. Thirteen of 40 patients with heparin-associated thrombocytopenia had 18 cardiovascular procedures done to save life or limb. Greenfield filters were placed in eight patients to prevent pulmonary embolism. Eight patients had 10 arterial procedures, with alternative anticoagulation that used dextran or warfarin in five cases. In three cases iloprost, a derivative of prostacyclin and a potent platelet inhibitor, was infused intraoperatively and heparin was given. Both the use of alternative anticoagulants and platelet suppression by iloprost were clinically effective strategies. The concurrent measurement of plasma levels of β-thromboglobulin and fibrinopeptide A in two patients confirmed that both approaches can successfully prevent activation of platelets and plasma coagulation during arterial surgery. One operative death occurred; all vascular reconstructions remained patent at 3 to 6 months. In two patients who received heparin alone for arterial surgery, both procedures resulted in thrombosis and limb loss. When major venous thromboembolism is complicated by heparin-associated thrombocytopenia, insertion of a Greenfield vena cava filter should be considered if there is significant risk of pulmonary embolism. When necessary, arterial surgery is feasible in patients with heparin-associated thrombocytopenia if alternative anticoagulation or adequate suppression of platelet reactivity can be achieved.

Use of the greenfield filter in adolescents for deep vein thrombosis and pulmonary embolism

Serious venous thromboembolic disease is now recognized more frequently in the pediatric age group. Caval interruption is indicated most commonly for prophylaxis against life-threatening or recurrent pulmonary embolism (PE) when anticoagulation is ineffective or contraindicated. Greenfield vena caval filters have been utilized locally in 415 adult patients with 97% long-term patency and 5% recurrent embolization. Its application in adolescents is reported herein. Standard adult (30-mm) vena caval filters were placed in ten patients, ages 13 to 18. Four filters were required following PE, six were used for deep venous thrombosis (DVT) when anticoagulation was contraindicated, and one was inserted prophylactically. In eight patients, filter insertion was accomplished with local anesthesia, while two underwent filter placement under general anesthesia administered for other procedures. One filter was misplaced into the right renal vein, requiring a second filter insertion. All patients have been followed from 1 to 11 years with yearly vascular duplex imaging and radionuclide venograms documenting caval patency without clinical embolic sequelae. This duplicates the adult experience in safety and efficacy. As recognition of venous thromboembolism becomes more frequent in the pediatric age group, safe caval interruption may be necessary for those excluded from or not responsive to anticoagulation. This technique may be extended to smaller patients with miniaturization of both filter and carrier.

Percutaneous Large Bore Venotomy and Tract Creation

We used a pig model to evaluate the pathologic changes that occur during large caliber percutaneous venotomy and tract creation such as is necessary to deliver the Greenfield vena caval filter. Four sequential dilator and four angioplasty balloon tract creations were performed on eight external jugular veins in four adult pigs. Gross and microscopic evaluations of the veins and surrounding tissue followed the procedures. Morphometric measurements based on extent and severity of pathologic changes in the specimens were graded from 0 (normal) to 3 (severe and/or extensive). We found that while either technique entailed damage to the veins, the sequential dilator method produced substantially more smooth muscle stretching and tearing and disruption of the internal elastica. There also was greater perivascular and intramural hemorrhage. These changes extended as far distally as the catheters and sheaths were advanced. While the number of experimental samples is too small to allow valid statistical analysis, our results suggest that the angioplasty balloon technique may be superior for tract and venotomy creation. Furthermore, large sheaths should be advanced only enough to maintain venous access to limit the extent of potential venous damage.

Percutaneous Placement of the Greenfield Vena Caval Filter

During the period from August 1986 to August 1987, 50 patients underwent percutaneous placement of a Greenfield vena caval filter from the right femoral vein, left femoral vein, or right internal jugular vein at our institution. All 50 patients had a contraindication to anticoagulation therapy or had complications of anticoagulation for deep venous thrombosis or pulmonary emboli. The percutaneous placement was accomplished in the angiographic suite with use of local anesthesia and was well tolerated by all patients. Only three complications related to the percutaneous approach occurred during the short-term follow-up (3 months to 1 year). These complications were deep venous thrombosis of the leg in two patients and misplacement of the filter in one patient. The three patients tolerated these complications well. We conclude that placement of Greenfield vena caval filters can be readily accomplished by means of percutaneous entry. Our experience demonstrated minimal associated morbidity and no mortality.