Experimental superior vena caval placement of the Greenfield filter

Max Langham, James C. Etheridge, Stephen L. Crute, Lazar J. Greenfield

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Pulmonary embolism (PE) from sources superior to the right atrium has been documented in several reports, but mechanical device protection has not been advised because of the morbidity associated with occlusion of the superior vena cava (SVC). Mechanical protection must maintain caval patency, protect against recurrent PE, and be safe. Since the Greenfield filter has fulfilled these criteria when placed in the inferior vena cava (IVC), we tested its suitability for use in the SVC in 11 dogs. Thrombus was harvested from phenolized segments of infrarenal vena cava and embolized into filters positioned in the SVC through the jugular or brachiocephalic vein under fluoroscopic guidance. Central venous pressure (CVP) was monitored before and after embolization. The dogs were allowed to recover and were followed up with monthly vena caval contrast studies and CVP measurements. After 3 months the animals were put to death and autopsies performed to determine the size of any residual thrombus and to examine the pulmonary arteries for signs of PE. Ten dogs had correct placement of the filter in the SVC; there were no perforations and no episodes of PE. CVP rose slightly after embolization into the filter but caval patency was maintained in all animals. Resolution of filter-entrapped thrombi occurred in all animals (mean initial weight = 1.02 gm, mean final weights = 0.11 gm, p < 0.05). In the eleventh animal the filter was discharged high, with one leg perforating the brachiocephalic vein. No hemorrhage or distal embolism occurred. Caval patency was maintained after embolization and at 3-month autopsy the perforated leg was encased in scar tissue without sign of infection or bleeding. This initial experience demonstrates that in dogs SVC placement of the Greenfield filter is well tolerated, protects against PE, and allows thrombus resolution while caval patency is maintained.

Original languageEnglish (US)
Pages (from-to)794-798
Number of pages5
JournalJournal of Vascular Surgery
Volume2
Issue number6
DOIs
StatePublished - Jan 1 1985

Fingerprint

Venae Cavae
Superior Vena Cava
Pulmonary Embolism
Central Venous Pressure
Thrombosis
Brachiocephalic Veins
Dogs
Autopsy
Leg
Hemorrhage
Weights and Measures
Jugular Veins
Inferior Vena Cava
Embolism
Heart Atria
Pulmonary Artery
Cicatrix
Morbidity
Equipment and Supplies
Infection

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Experimental superior vena caval placement of the Greenfield filter. / Langham, Max; Etheridge, James C.; Crute, Stephen L.; Greenfield, Lazar J.

In: Journal of Vascular Surgery, Vol. 2, No. 6, 01.01.1985, p. 794-798.

Research output: Contribution to journalArticle

Langham, Max ; Etheridge, James C. ; Crute, Stephen L. ; Greenfield, Lazar J. / Experimental superior vena caval placement of the Greenfield filter. In: Journal of Vascular Surgery. 1985 ; Vol. 2, No. 6. pp. 794-798.
@article{31f79057a6d843999b8b1ea34fb5acaf,
title = "Experimental superior vena caval placement of the Greenfield filter",
abstract = "Pulmonary embolism (PE) from sources superior to the right atrium has been documented in several reports, but mechanical device protection has not been advised because of the morbidity associated with occlusion of the superior vena cava (SVC). Mechanical protection must maintain caval patency, protect against recurrent PE, and be safe. Since the Greenfield filter has fulfilled these criteria when placed in the inferior vena cava (IVC), we tested its suitability for use in the SVC in 11 dogs. Thrombus was harvested from phenolized segments of infrarenal vena cava and embolized into filters positioned in the SVC through the jugular or brachiocephalic vein under fluoroscopic guidance. Central venous pressure (CVP) was monitored before and after embolization. The dogs were allowed to recover and were followed up with monthly vena caval contrast studies and CVP measurements. After 3 months the animals were put to death and autopsies performed to determine the size of any residual thrombus and to examine the pulmonary arteries for signs of PE. Ten dogs had correct placement of the filter in the SVC; there were no perforations and no episodes of PE. CVP rose slightly after embolization into the filter but caval patency was maintained in all animals. Resolution of filter-entrapped thrombi occurred in all animals (mean initial weight = 1.02 gm, mean final weights = 0.11 gm, p < 0.05). In the eleventh animal the filter was discharged high, with one leg perforating the brachiocephalic vein. No hemorrhage or distal embolism occurred. Caval patency was maintained after embolization and at 3-month autopsy the perforated leg was encased in scar tissue without sign of infection or bleeding. This initial experience demonstrates that in dogs SVC placement of the Greenfield filter is well tolerated, protects against PE, and allows thrombus resolution while caval patency is maintained.",
author = "Max Langham and Etheridge, {James C.} and Crute, {Stephen L.} and Greenfield, {Lazar J.}",
year = "1985",
month = "1",
day = "1",
doi = "10.1016/0741-5214(85)90124-7",
language = "English (US)",
volume = "2",
pages = "794--798",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Experimental superior vena caval placement of the Greenfield filter

AU - Langham, Max

AU - Etheridge, James C.

AU - Crute, Stephen L.

AU - Greenfield, Lazar J.

PY - 1985/1/1

Y1 - 1985/1/1

N2 - Pulmonary embolism (PE) from sources superior to the right atrium has been documented in several reports, but mechanical device protection has not been advised because of the morbidity associated with occlusion of the superior vena cava (SVC). Mechanical protection must maintain caval patency, protect against recurrent PE, and be safe. Since the Greenfield filter has fulfilled these criteria when placed in the inferior vena cava (IVC), we tested its suitability for use in the SVC in 11 dogs. Thrombus was harvested from phenolized segments of infrarenal vena cava and embolized into filters positioned in the SVC through the jugular or brachiocephalic vein under fluoroscopic guidance. Central venous pressure (CVP) was monitored before and after embolization. The dogs were allowed to recover and were followed up with monthly vena caval contrast studies and CVP measurements. After 3 months the animals were put to death and autopsies performed to determine the size of any residual thrombus and to examine the pulmonary arteries for signs of PE. Ten dogs had correct placement of the filter in the SVC; there were no perforations and no episodes of PE. CVP rose slightly after embolization into the filter but caval patency was maintained in all animals. Resolution of filter-entrapped thrombi occurred in all animals (mean initial weight = 1.02 gm, mean final weights = 0.11 gm, p < 0.05). In the eleventh animal the filter was discharged high, with one leg perforating the brachiocephalic vein. No hemorrhage or distal embolism occurred. Caval patency was maintained after embolization and at 3-month autopsy the perforated leg was encased in scar tissue without sign of infection or bleeding. This initial experience demonstrates that in dogs SVC placement of the Greenfield filter is well tolerated, protects against PE, and allows thrombus resolution while caval patency is maintained.

AB - Pulmonary embolism (PE) from sources superior to the right atrium has been documented in several reports, but mechanical device protection has not been advised because of the morbidity associated with occlusion of the superior vena cava (SVC). Mechanical protection must maintain caval patency, protect against recurrent PE, and be safe. Since the Greenfield filter has fulfilled these criteria when placed in the inferior vena cava (IVC), we tested its suitability for use in the SVC in 11 dogs. Thrombus was harvested from phenolized segments of infrarenal vena cava and embolized into filters positioned in the SVC through the jugular or brachiocephalic vein under fluoroscopic guidance. Central venous pressure (CVP) was monitored before and after embolization. The dogs were allowed to recover and were followed up with monthly vena caval contrast studies and CVP measurements. After 3 months the animals were put to death and autopsies performed to determine the size of any residual thrombus and to examine the pulmonary arteries for signs of PE. Ten dogs had correct placement of the filter in the SVC; there were no perforations and no episodes of PE. CVP rose slightly after embolization into the filter but caval patency was maintained in all animals. Resolution of filter-entrapped thrombi occurred in all animals (mean initial weight = 1.02 gm, mean final weights = 0.11 gm, p < 0.05). In the eleventh animal the filter was discharged high, with one leg perforating the brachiocephalic vein. No hemorrhage or distal embolism occurred. Caval patency was maintained after embolization and at 3-month autopsy the perforated leg was encased in scar tissue without sign of infection or bleeding. This initial experience demonstrates that in dogs SVC placement of the Greenfield filter is well tolerated, protects against PE, and allows thrombus resolution while caval patency is maintained.

UR - http://www.scopus.com/inward/record.url?scp=0022377062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022377062&partnerID=8YFLogxK

U2 - 10.1016/0741-5214(85)90124-7

DO - 10.1016/0741-5214(85)90124-7

M3 - Article

VL - 2

SP - 794

EP - 798

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 6

ER -