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 - 1991/9
Y1 - 1991/9
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.
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U2 - 10.1016/0741-5214(91)90074-5
DO - 10.1016/0741-5214(91)90074-5
M3 - Article
C2 - 1880833
AN - SCOPUS:0026228906
SN - 0741-5214
VL - 14
SP - 253
EP - 257
JO - Journal of vascular surgery
JF - Journal of vascular surgery
IS - 3
ER -