Superior vena caval Greenfield filters: Indications, techniques, and results

Purpose: This study assessed the clinical feasibility of placement of the titanium Greenfield filter within the superior vena cava (SVC) in patients with upper extremity deep venous thrombosis and evaluated the short-term results. Methods: During the past 14 months, we have encountered six patients who had upper extremity central venous thrombosis in whom anticoagulation was deemed either contraindicated or ineffective in preventing recurrent pulmonary embolism. All patients underwent percutaneous insertion of a Greenfield filter into the SVC for prophylaxis for pulmonary embolism. Two of these patients had already undergone insertion of an inferior vena cava filter and two other patients had simultaneous insertion of SVC and inferior vena caval filters. Results: No complication such as filter migration, misplacement, excessive hemorrhage, or pneumothorax occurred. Two patients subsequently underwent uncomplicated insertion of a Swan-Ganz catheter despite the presence of the filter. Two patients died of unrelated causes without clinical evidence of complications related to the filter. During the follow-up period from 4 to 14 months, there was no clinical evidence of pulmonary embolism in the remaining four patients. Conclusion: This procedure can be performed safely and is effective for the prevention of pulmonary embolism in patients with upper extremity venous thrombosis.