Greenfield Filter

From Anvita Health Wiki

Contents 1 Introduction 2 Clinical-significance 3 Procedure 4 Complications 5 References

Introduction

• Indication(s):
• high risk of pulmonary embolism in a patient with contraindication(s) to anticoagulation

Clinical-significance

• the effective span of a Greenfield filter is about 7-10 years due to development of collateral circulation around the filter
• these collaterals, however, will be smaller caliber vessels than the inferior vena cava & may themselves provide a filter of a sort

Procedure

• umbrella device inserted into the inferior vena cava by means of a catheter introduced into the femoral vein
• once in place, the umbrella opens, providing a filter to prevent emboli originating in the large veins of the lower extremities (i.e. femoral vein) from lodging in the pulmonary vasculature (i.e. pulmonary embolism)

Complications

• pulmonary embolism occurs in 2.5% of patients despite placement of a Greenfield filter
• filter migration
• fracture & embolization of the filter itself

• to the heart

• ventricular tachycardia
• cardiac tamponade
• sudden death

• inferior vena cava perforation [2]

References

1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 778
2. FDA MedWatch Inferior Vena Cava (IVC) Filters: Initial Communication: Risk of Adverse Events with Long Term Use [1]
   - Nicholson W et al Prevalence of Fracture and Fragment Embolization of Bard Retrievable Vena Cava Filters and Clinical Implications Including Cardiac Perforation and Tamponade Arch Intern Med. Published online August 9, 2010 <PubMed> PMID: [2] <Internet> [3]
3. National Guideline Clearinghouse
   - ACR Appropriateness Criteria<TM> inferior vena cava (IVC) filter placement. American College of Radiology ngc-guideline: [4]
   - ACR-SIR practice guideline for the performance of inferior vena cava (IVC) filter placement for the prevention of pulmonary embolism. American College of Radiology ngc-guideline: [5]

Greenfield filter; umbrella; inferior vena cava filter