Greenfield vena Caval Filter: St. Joseph's Hospital Experiences

Abstract

Since the first vena caval filter was inserted at St. Joseph's Hospital in 1979, 18 similar procedures have been performed. A review of these cases was con ducted in which the indications for and site of insertion, associated diagnostic and radiographic studies, complications, and mortality were summarized. The data reveal a mortality rate of 11 %, owing primarily to the use of the filter in hemodynamically unstable patients with massive pulmonary emboli. This figure suggests that vena caval filters should only be used as a truly pro phylactic measure, limiting the indications for insertion to failures of or contra indications to anticoagulation, as well as possible consideration as prophylaxis in high risk patients or those with "free floating" thrombus above the inguinal ligament. Such failures of anticoagulation and complications of overtreatment can be minimized through an understanding of the variable response to anticoagulants and the recognition of the need for accurate, frequent monitoring of anticoagu lant therapy.