Greenfield L J, Michna B A
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Surgery. 1988 Oct;104(4):706-12.
Optimal protection from pulmonary thromboembolism (PE) by a mechanical device requires long-term freedom from complications as well as from recurrent PE. From 1974 to 1986 the Greenfield filter was implanted surgically in 469 patients, most commonly when anticoagulation was contraindicated (38%) or failed to prevent recurrent PE (27%). The jugular vein was used for access in 83% and the femoral vein in 16%; in the remainder the filter was inserted via the right atrium or the left axillary vein. Technical complications included air embolism in 4 patients (0.9%) and misplacement in 19 (4%), with no sequelae. There were 7 deaths from PE within 48 hours postoperatively, primarily in patients with pulmonary hypertension. An additional 9 later deaths were attributed to PE, 5 confirmed by autopsy, but in only 1 of these was there trapped thrombus in the filter. An additional 9 patients had nonfatal PE, suspected and confirmed in 2 by angiogram, for an overall recurrent PE rate of 4% over 12 years. During this follow-up there were 133 deaths, and 146 patients were followed up for an average of 43 months (190 were lost to follow-up). Ten patients had thrombosed inferior venae cavae at the time of insertion of the Greenfield filter, and 3 were recanalized late to a caval patency rate of 96%. Three initially patent filters occluded, for a long-term filter patency rate of 98%, which was independent of anticoagulation. Clinically silent embolism into the Greenfield filter was seen in 18 patients, half of whom had dissolution on subsequent cavogram. Venous stasis sequelae developed in 44% of the patients, compared with 52% with preoperative edema, and ulceration was seen in 3%. Of 32 patients who had suprarenal filters, 11 died and 12 returned for follow-up study, which showed that all were patent. Favorable results with suprarenal filter placement have made this an appropriate choice in pregnant women and in young women anticipating pregnancy.
机械装置对肺血栓栓塞症（PE）的最佳保护需要长期无并发症以及无复发性PE。1974年至1986年期间，469例患者接受了格林菲尔德过滤器的外科植入，最常见的情况是抗凝治疗禁忌（38%）或未能预防复发性PE（27%）。83%的患者通过颈静脉置入，16%通过股静脉置入；其余患者通过右心房或左腋静脉插入过滤器。技术并发症包括4例（0.9%）空气栓塞和19例（4%）位置不当，均无后遗症。术后48小时内有7例死于PE，主要是肺动脉高压患者。另有9例后期死亡归因于PE，5例经尸检证实，但其中只有1例过滤器中有血栓形成。另有9例患者发生非致命性PE，2例经血管造影怀疑并证实，12年期间总体复发性PE发生率为4%。在该随访期间，有133例死亡，146例患者平均随访43个月（190例失访）。10例患者在插入格林菲尔德过滤器时下腔静脉已血栓形成，3例后期再通，下腔静脉通畅率为96%。3个最初通畅的过滤器发生堵塞，长期过滤器通畅率为98%，与抗凝无关。18例患者出现进入格林菲尔德过滤器的临床无症状栓塞，其中一半在随后的腔静脉造影中溶解。44%的患者出现静脉淤滞后遗症，术前有水肿的患者为52%，3%的患者出现溃疡。32例植入肾上过滤器的患者中，11例死亡，12例返回进行随访研究，结果显示所有过滤器均通畅。肾上过滤器置入的良好结果使其成为孕妇和预期怀孕的年轻女性的合适选择。
