Analysis of the transition to percutaneous placement of Greenfield filters.

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.