Inferior Vena Cava Interruption for the Prevention of Pulmonary Emboli: Advantages, Disadvantages, and Complications

Abstract

Pulmonary embolism (PE) in high-risk patients is minimized by inferior vena caval interruption by ligation, plication/clipping, intraluminal filters, or intralu minal balloons. Vena caval filter implantation is the least traumatic of all surgi cal implantation is the least traumatic of all surgical methods of preventing PE. These nonocclusive methods are preferred to minimize the possible sequelae of venous insufficiency. The prevention of septic emboli requires complete liga tion of the inferior vena cava (IVC). The transvenous approach to IVC inter ruption by intraluminal filter is particularly useful in severely ill patients. The Kim-Ray Greenfield filters are at present the most frequently used mo dalities for prevention of fatal PE when intervention is required. In a large ser ies of patients who have had the Greenfield filer implanted, there has been an operative mortality of less than 1%, with an incidence of recurrent emboli of less than 2%, and an incidence of venous stasis sequelae of approximately 20%. In general, this device has greater ease and flexibility of placement with lower mortality and morbidity rates.