Single institution prospective evaluation of the over-the-wire Greenfield vena caval filter

Abstract

Purpose: To assess the technical and clinical success of the over-the-wire (OTW) Greenfield inferior vena caval (IVC) filter.

Materials and methods: Prospective evaluation of the OTW Greenfield filter in 47 patients was performed during the course of 18 months. Technical success and deployment problems were documented. Caval perforation, leg asymmetry, and tilt were evaluated with a postprocedure, noncontrast computed tomographic (CT) scan. Follow-up was performed at 6- and 12-month intervals after the procedure and included a clinical history, chart review, and magnetic resonance (MR) imaging examination of the IVC.

Results: Ninety-one percent of filters were placed without technical difficulties and 100% were successfully deployed. Technical difficulties included sheath kinking prior to deployment (n = 3), initial incomplete filter opening (n = 1), and wire entrapment within the filter (n = 1). Of 38 patients evaluated with CT, there was no case of caval perforation. Twenty-one patients (55%) demonstrated tilt and 14 (37%) had leg asymmetry. Tilting occurred more frequently when the filter was placed from a femoral approach (51%) than from a jugular approach (12%). Of patients with leg asymmetry, the vena cava was narrow in anteroposterior (AP) dimension in five (36%). Of 13 deaths, none were attributed to pulmonary embolism. One patient (2%) had a recurrent pulmonary embolus. Two of 16 patients (12%) with MR imaging follow-up had documented IVC thrombosis.

Conclusions: The OTW Greenfield filter has an effective delivery system, with few difficulties encountered during deployment. Filter tilt and leg asymmetry are common. The etiology of leg asymmetry is likely multifactorial but is often associated with a cava with a small AP diameter. Because OTW deployment appears to offer no benefit in centering the filter, the authors have elected to remove the wire prior to filter deployment to avoid possible entanglement. MR imaging follow-up reveals an acceptable incidence of IVC thrombosis.