Results of a multicenter study of the modified hook-titanium Greenfield filter

Lazar J. Greenfield, Kyung J. Cho, Mary Proctor, Joseph Bonn, Joseph J. Bookstein, Wilfrido R. Castaneda-Zuniga, Bruce Cutler, Ernest J. Ferris, Frederick Keller, Timothy McCowan, S. Osher Pais, Michael Sobel, Jaime Tisnado, Arthur C. Waltman

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Initial efforts to modify the stainless steel Greenfield filter for percutaneous insertion led to development of a titanium Greenfield filter, which could be inserted by use of a 12F carrier. This device functioned well as a filter but had an unacceptable 30% rate of migration, tilting, and penetration. Therefore a titanium Greenfield filter with modified hooks was developed and has been tested in 186 patients at 10 institutions. Successful placement occurred in 181 (97%); placement of the remainder was precluded by unfavorable anatomy. A contraindication to anticoagulation was the most frequent indication for insertion (75%). All but two were inserted percutaneously, predominantly via the right femoral vein (70%). Initial incomplete opening was seen in four patients (2%), which was corrected by guide wire manipulation and asymmetry of the legs in 10 (5.4%). Insertion site hematoma occurred in one patient, and apical penetration of the cava during insertion occurred in a second patient. Both events were without sequelae. Follow-up examinations were performed at 30 days at which time 35 deaths had occurred. Recurrent embolism was suspected in six patients (3%) and two of three deaths were confirmed by autopsy. Filter movement > 9 mm was seen in 13 patients, (11%) and increase in base diameter ≥5 mm was seen in 17 patients (14%). CT scanning showed evidence of caval penetration in only one patient (0.8%). Insertion site venous thrombosis was seen in 4/46 (8.7%) patients screened. The modified hook titanium Greenfield filter is inserted percutaneously or operatively through a sheath, eliminating concern for misplacement from premature discharge. The modified hook design has reduced the incidence of migration and caval penetration, but proper orientation of the carrier in the vena cava is necessary to avoid leg asymmetry. No evidence was found of filter occlusion, but longer follow-up is needed to confirm late patency equivalent to the standard Greenfield filter.

Original languageEnglish (US)
Pages (from-to)253-257
Number of pages5
JournalJournal of Vascular Surgery
Volume14
Issue number3
DOIs
StatePublished - 1991
Externally publishedYes

Fingerprint

Titanium
Multicenter Studies
Venae Cavae
Leg
Femoral Vein
Stainless Steel
Embolism
Venous Thrombosis
Hematoma
Autopsy
Anatomy
Equipment and Supplies
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Greenfield, L. J., Cho, K. J., Proctor, M., Bonn, J., Bookstein, J. J., Castaneda-Zuniga, W. R., ... Waltman, A. C. (1991). Results of a multicenter study of the modified hook-titanium Greenfield filter. Journal of Vascular Surgery, 14(3), 253-257. https://doi.org/10.1016/0741-5214(91)90074-5

Results of a multicenter study of the modified hook-titanium Greenfield filter. / Greenfield, Lazar J.; Cho, Kyung J.; Proctor, Mary; Bonn, Joseph; Bookstein, Joseph J.; Castaneda-Zuniga, Wilfrido R.; Cutler, Bruce; Ferris, Ernest J.; Keller, Frederick; McCowan, Timothy; Pais, S. Osher; Sobel, Michael; Tisnado, Jaime; Waltman, Arthur C.

In: Journal of Vascular Surgery, Vol. 14, No. 3, 1991, p. 253-257.

Research output: Contribution to journalArticle

Greenfield, LJ, Cho, KJ, Proctor, M, Bonn, J, Bookstein, JJ, Castaneda-Zuniga, WR, Cutler, B, Ferris, EJ, Keller, F, McCowan, T, Pais, SO, Sobel, M, Tisnado, J & Waltman, AC 1991, 'Results of a multicenter study of the modified hook-titanium Greenfield filter', Journal of Vascular Surgery, vol. 14, no. 3, pp. 253-257. https://doi.org/10.1016/0741-5214(91)90074-5
Greenfield LJ, Cho KJ, Proctor M, Bonn J, Bookstein JJ, Castaneda-Zuniga WR et al. Results of a multicenter study of the modified hook-titanium Greenfield filter. Journal of Vascular Surgery. 1991;14(3):253-257. https://doi.org/10.1016/0741-5214(91)90074-5
Greenfield, Lazar J. ; Cho, Kyung J. ; Proctor, Mary ; Bonn, Joseph ; Bookstein, Joseph J. ; Castaneda-Zuniga, Wilfrido R. ; Cutler, Bruce ; Ferris, Ernest J. ; Keller, Frederick ; McCowan, Timothy ; Pais, S. Osher ; Sobel, Michael ; Tisnado, Jaime ; Waltman, Arthur C. / Results of a multicenter study of the modified hook-titanium Greenfield filter. In: Journal of Vascular Surgery. 1991 ; Vol. 14, No. 3. pp. 253-257.
@article{02515c430c2a4ae99d35d11d5e0b58ca,
title = "Results of a multicenter study of the modified hook-titanium Greenfield filter",
abstract = "Initial efforts to modify the stainless steel Greenfield filter for percutaneous insertion led to development of a titanium Greenfield filter, which could be inserted by use of a 12F carrier. This device functioned well as a filter but had an unacceptable 30{\%} rate of migration, tilting, and penetration. Therefore a titanium Greenfield filter with modified hooks was developed and has been tested in 186 patients at 10 institutions. Successful placement occurred in 181 (97{\%}); placement of the remainder was precluded by unfavorable anatomy. A contraindication to anticoagulation was the most frequent indication for insertion (75{\%}). All but two were inserted percutaneously, predominantly via the right femoral vein (70{\%}). Initial incomplete opening was seen in four patients (2{\%}), which was corrected by guide wire manipulation and asymmetry of the legs in 10 (5.4{\%}). Insertion site hematoma occurred in one patient, and apical penetration of the cava during insertion occurred in a second patient. Both events were without sequelae. Follow-up examinations were performed at 30 days at which time 35 deaths had occurred. Recurrent embolism was suspected in six patients (3{\%}) and two of three deaths were confirmed by autopsy. Filter movement > 9 mm was seen in 13 patients, (11{\%}) and increase in base diameter ≥5 mm was seen in 17 patients (14{\%}). CT scanning showed evidence of caval penetration in only one patient (0.8{\%}). Insertion site venous thrombosis was seen in 4/46 (8.7{\%}) patients screened. The modified hook titanium Greenfield filter is inserted percutaneously or operatively through a sheath, eliminating concern for misplacement from premature discharge. The modified hook design has reduced the incidence of migration and caval penetration, but proper orientation of the carrier in the vena cava is necessary to avoid leg asymmetry. No evidence was found of filter occlusion, but longer follow-up is needed to confirm late patency equivalent to the standard Greenfield filter.",
author = "Greenfield, {Lazar J.} and Cho, {Kyung J.} and Mary Proctor and Joseph Bonn and Bookstein, {Joseph J.} and Castaneda-Zuniga, {Wilfrido R.} and Bruce Cutler and Ferris, {Ernest J.} and Frederick Keller and Timothy McCowan and Pais, {S. Osher} and Michael Sobel and Jaime Tisnado and Waltman, {Arthur C.}",
year = "1991",
doi = "10.1016/0741-5214(91)90074-5",
language = "English (US)",
volume = "14",
pages = "253--257",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Results of a multicenter study of the modified hook-titanium Greenfield filter

AU - Greenfield, Lazar J.

AU - Cho, Kyung J.

AU - Proctor, Mary

AU - Bonn, Joseph

AU - Bookstein, Joseph J.

AU - Castaneda-Zuniga, Wilfrido R.

AU - Cutler, Bruce

AU - Ferris, Ernest J.

AU - Keller, Frederick

AU - McCowan, Timothy

AU - Pais, S. Osher

AU - Sobel, Michael

AU - Tisnado, Jaime

AU - Waltman, Arthur C.

PY - 1991

Y1 - 1991

N2 - Initial efforts to modify the stainless steel Greenfield filter for percutaneous insertion led to development of a titanium Greenfield filter, which could be inserted by use of a 12F carrier. This device functioned well as a filter but had an unacceptable 30% rate of migration, tilting, and penetration. Therefore a titanium Greenfield filter with modified hooks was developed and has been tested in 186 patients at 10 institutions. Successful placement occurred in 181 (97%); placement of the remainder was precluded by unfavorable anatomy. A contraindication to anticoagulation was the most frequent indication for insertion (75%). All but two were inserted percutaneously, predominantly via the right femoral vein (70%). Initial incomplete opening was seen in four patients (2%), which was corrected by guide wire manipulation and asymmetry of the legs in 10 (5.4%). Insertion site hematoma occurred in one patient, and apical penetration of the cava during insertion occurred in a second patient. Both events were without sequelae. Follow-up examinations were performed at 30 days at which time 35 deaths had occurred. Recurrent embolism was suspected in six patients (3%) and two of three deaths were confirmed by autopsy. Filter movement > 9 mm was seen in 13 patients, (11%) and increase in base diameter ≥5 mm was seen in 17 patients (14%). CT scanning showed evidence of caval penetration in only one patient (0.8%). Insertion site venous thrombosis was seen in 4/46 (8.7%) patients screened. The modified hook titanium Greenfield filter is inserted percutaneously or operatively through a sheath, eliminating concern for misplacement from premature discharge. The modified hook design has reduced the incidence of migration and caval penetration, but proper orientation of the carrier in the vena cava is necessary to avoid leg asymmetry. No evidence was found of filter occlusion, but longer follow-up is needed to confirm late patency equivalent to the standard Greenfield filter.

AB - Initial efforts to modify the stainless steel Greenfield filter for percutaneous insertion led to development of a titanium Greenfield filter, which could be inserted by use of a 12F carrier. This device functioned well as a filter but had an unacceptable 30% rate of migration, tilting, and penetration. Therefore a titanium Greenfield filter with modified hooks was developed and has been tested in 186 patients at 10 institutions. Successful placement occurred in 181 (97%); placement of the remainder was precluded by unfavorable anatomy. A contraindication to anticoagulation was the most frequent indication for insertion (75%). All but two were inserted percutaneously, predominantly via the right femoral vein (70%). Initial incomplete opening was seen in four patients (2%), which was corrected by guide wire manipulation and asymmetry of the legs in 10 (5.4%). Insertion site hematoma occurred in one patient, and apical penetration of the cava during insertion occurred in a second patient. Both events were without sequelae. Follow-up examinations were performed at 30 days at which time 35 deaths had occurred. Recurrent embolism was suspected in six patients (3%) and two of three deaths were confirmed by autopsy. Filter movement > 9 mm was seen in 13 patients, (11%) and increase in base diameter ≥5 mm was seen in 17 patients (14%). CT scanning showed evidence of caval penetration in only one patient (0.8%). Insertion site venous thrombosis was seen in 4/46 (8.7%) patients screened. The modified hook titanium Greenfield filter is inserted percutaneously or operatively through a sheath, eliminating concern for misplacement from premature discharge. The modified hook design has reduced the incidence of migration and caval penetration, but proper orientation of the carrier in the vena cava is necessary to avoid leg asymmetry. No evidence was found of filter occlusion, but longer follow-up is needed to confirm late patency equivalent to the standard Greenfield filter.

UR - http://www.scopus.com/inward/record.url?scp=0026228906&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026228906&partnerID=8YFLogxK

U2 - 10.1016/0741-5214(91)90074-5

DO - 10.1016/0741-5214(91)90074-5

M3 - Article

C2 - 1880833

AN - SCOPUS:0026228906

VL - 14

SP - 253

EP - 257

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 3

ER -