[Partial interruption of the inferior vena cava using a percutaneous endovenous filter]

Abstract

Partial interruption of the inferior vena cava (IVCI) by a percutaneous endovenous filter (Günther filter n = 65, LEM filter n = 36) was undertaken in 100 patients with an average of 72 +/- 11 years for recent deep vein thrombosis. The indications were: contraindications to anticoagulant therapy (36.5%); recurrent pulmonary embolism (12%); threatening venous thrombosis with a previous embolic episode (12%); caval thrombosis (15.7%); prophylactic, with no previous pulmonary embolism (23.8%). The filters were evaluated at short and mid term. There were no technical problems. The mortality rate was 17.5%, one death being probably due to recurrent pulmonary embolism. No other recurrences of pulmonary embolism were observed, indicating an efficacy of 99 per cent. The early patency rate was 96.5%, there being no difference between the two filters used, independent of the initial site of venous thrombosis, of distal migration of the filter and associated medical treatment (anticoagulation). Distal migration was observed in 76% of IVCI by the Günther filter and 48.5% by the LEM filter (p less than 0.001); tilting was observed in 7.4% of Günther and 3% of LEM filters. Five LEM filters were incompletely opened. The IVC was transfixed by 3 Günther filters. One Günther filter had fractured spokes. There were 12 recurrences of lower limb deep vein thrombosis and 16 post-deep vein thrombosis complications were recorded. These percutaneous endovenous filters are similar to the Kimray Greenfield filter with respect to efficacy and permeability although the follow-up was relatively short. The advantages of these percutaneous filters are the facility, innocuity and rapidity of their insertion with, however, a higher incidence of distal migration.