Interruption of the inferior vena cava for the prevention of recurrent pulmonary embolism

Abstract

Pulmonary embolism in high-risk patients may be minimized by inferior vena caval interruption by ligation, plication, intraluminal filters, or intraluminal balloons. Vena caval filter implantation is the least traumatic of all surgical methods of preventing pulmonary embolism. These nonocclusive methods are preferred to minimize the possible sequelae of venous insufficiency. The prevention of septic emboli requires complete ligation of the inferior vena cava. The transvenous approach to caval interruption by intraluminal filters is particularly useful in severely ill patients. When major surgical procedures are performed for the purpose of caval interruption, the intra-abdominal approach has greater associated mortality and morbidity than does the retroperitoneal approach. The Mobin-Uddin and Kim-Ray Greenfield filters are at present the most frequently used modalities for prevention of fatal pulmonary embolism when intervention is required. In large series of patients where intraluminal caval filters have been utilized, there has been an operative mortality of under 1 per cent, with an incidence of recurrent emboli of under 2 per cent, and an incidence of venous stasis sequelae of approximately 20 per cent. Some clinicians prefer the Greenfield filter over the Mobin-Uddin umbrella because of greater ease and flexibility of placement. In general, however, both transvenous intraluminal filters have been used effectively with acceptable mortality and morbidity, and the device used might properly be determined by the experience of the surgeon.