Fink J A, Jones B T
Department of Surgery, Akron City Hospital, Ohio 44309.
Surg Gynecol Obstet. 1991 Apr;172(4):253-6.
During a five year period at Akron City Hospital, 165 Greenfield filters were placed in 165 patients. Of this group, 78 patients were available for long term analysis, and of these, 42 did not receive anticoagulation treatment for venous thromboembolic diseases, either acutely or on an outpatient basis. An analysis of the outcome for these 42 patients who had the Greenfield filter only as the primary mode of therapy for the disease included chart review and asking each person a standard set of questions. Leg swelling was the most common complaint, occurring in 33 per cent of patients. Venous stasis ulceration occurred in two patients and recurrent deep venous thrombosis occurred in one patient. When compared with a historical control group with venous thromboembolic disease that was treated with anticoagulation alone, the incidence of these sequelae in Greenfield-treated patients was not significantly different. Finally, in this review, the Greenfield filter is better than 95 per cent effective in the prevention of pulmonary embolism. This is no less effective than anticoagulation alone, the efficacy of which is 95 to 98 per cent. The placement of a Greenfield filter is a safe procedure that can usually be done after a local anesthetic was administered to the patient with a complication rate of less than 10 per cent. Unfortunately, major complications of anticoagulation (usually hemorrhage) are relatively common at a rate of 2 to 15 per cent, and occur more frequently in the older population. It is for reasons of safety of therapy and of an equal or better efficacy that the Greenfield filter is recommended in a broader range of clinical circumstances. In particular, it is concluded that the Greenfield filter should be used as a primary means of therapy in venous thromboembolic disease, particularly in those patients who are more than 65 years of age, when the risks of anticoagulation are most threatening.
在阿克伦市医院的五年时间里，165名患者植入了165个格林菲尔德滤器。在这组患者中，78名患者可进行长期分析，其中42名患者未接受针对静脉血栓栓塞性疾病的急性或门诊抗凝治疗。对这42名仅将格林菲尔德滤器作为该疾病主要治疗方式的患者的治疗结果进行分析，包括病历审查和向每个人询问一组标准问题。腿部肿胀是最常见的主诉，33%的患者出现该症状。两名患者发生静脉淤滞性溃疡，一名患者出现复发性深静脉血栓形成。与仅接受抗凝治疗的静脉血栓栓塞性疾病历史对照组相比，接受格林菲尔德滤器治疗的患者中这些后遗症的发生率无显著差异。最后，在本次综述中，格林菲尔德滤器预防肺栓塞的有效率超过95%。这与单独抗凝治疗的效果相当，单独抗凝治疗的有效率为95%至98%。植入格林菲尔德滤器是一种安全的手术，通常在对患者进行局部麻醉后即可进行，并发症发生率低于10%。不幸的是，抗凝治疗的主要并发症（通常为出血）相对常见，发生率为2%至15%，且在老年人群中更频繁发生。出于治疗安全性和疗效相同或更好的原因，格林菲尔德滤器在更广泛的临床情况下被推荐使用。特别是，得出结论认为，格林菲尔德滤器应作为静脉血栓栓塞性疾病的主要治疗手段，尤其是在65岁以上的患者中，此时抗凝治疗的风险最为严重。
