Analysis of the transition to percutaneous placement of Greenfield filters
R. J. Hye, A. T. Mitchell, C. E. Dory, J. A. Freischlag and A. C. Roberts
Department of Surgery, Veterans Affairs Medical Center, San Diego, Calif.
To establish whether a transition from surgical to percutaneous placement
of Greenfield filters was justified, a review of the safety, efficacy, and
cost-effectiveness of the two approaches was conducted. Between 1984 and
1989, 168 filters were placed in 169 patients, 48 surgically and 120
percutaneously. Placement was successful in 45 (94%) of the 48 surgical
patients and 120 (99%) of the 121 percutaneous patients. Filter
misplacement occurred in three (6%) surgical patients and no percutaneous
patients. Clinically evident femoral vein thrombosis occurred in only four
(5%) of the percutaneous patients, while inferior vena cava thrombosis
occurred in three (3%) of the percutaneous patients. One pulmonary embolus
occurred after percutaneous filter placement and resulted in death. The
cost of percutaneous placement was 58% that of surgical placement. A
retrospective review of the experience in our patient population indicates
that safety, cost, and ease of insertion make the percutaneous approach the
procedure of choice for Greenfield filter placement.
