Greenfield L J, Cho K J, Proctor M C, Sobel M, Shah S, Wingo J
Department of Surgery, University of Michigan, Ann Arbor.
Arch Surg. 1992 Aug;127(8):969-73. doi: 10.1001/archsurg.1992.01420080103017.
Placement of the Greenfield filter above the renal veins was necessary in 71 (9%) of 821 total patients in the filter registries of two institutions. The status of 60 patients (85%) could be verified, with follow-up data ranging from 18 months to 16 years (average, 53 months). Of 24 deaths (34%), none was from recurrent embolism or renal failure; death was most commonly associated with a malignant neoplasm. The recurrent embolism rate was 4%, identical to the infrarenal experience. Duplex evaluation of the filters in 22 patients, representing the majority (61%) of living patients, showed that all the filters were patent. Sixteen patients (41%) had lower-extremity edema that predated filter insertion, and in no patient did the results of noninvasive venous studies worsen. Filter fracture (two patients) or distal migration (two patients) had no clinical sequelae, and there was no evidence of renal dysfunction. For thrombus extending to the level of the renal veins or within them and for pregnant patients or women of childbearing age, suprarenal placement of the Greenfield filter is safe and effective, with no filter obstruction seen in follow-up extending to 16 years.
在两家机构的滤器登记处的821例患者中，71例（9%）需要将格林菲尔德滤器放置在肾静脉上方。60例患者（85%）的情况可得到证实，随访数据从18个月至16年不等（平均53个月）。在24例死亡患者（34%）中，无一例死于复发性栓塞或肾衰竭；死亡最常见与恶性肿瘤相关。复发性栓塞率为4%，与肾下放置滤器的情况相同。对22例患者（占存活患者的大多数，61%）的滤器进行双功超声评估显示，所有滤器均通畅。16例患者（41%）在滤器置入前就有下肢水肿，无创静脉检查结果在任何患者中均未恶化。滤器断裂（2例患者）或远端移位（2例患者）均无临床后遗症，也没有肾功能不全的证据。对于血栓延伸至肾静脉水平或肾静脉内的患者以及孕妇或育龄妇女，格林菲尔德滤器肾上放置是安全有效的，在长达16年的随访中未见滤器阻塞。
