Hunter vena cava balloon: rationale and results.

The majority of patients with venous thromboembolism are successfully managed with anticoagulation therapy, but certain patients require inferior vena cava (IVC) interruption. Traditional open operations on the IVC have important disadvantages, among which are significant morbidity and mortality. Twenty years ago work began to develop a transvenous method to interrupt the IVC. As the requirements for a safe and effective method were defined, it became apparent that the best approach would be with a catheter-delivered detachable balloon secured by hyperinflation in the distensible IVC. The concept of a "filter" was discarded because of predicted problems with thrombosis, induced embolism, and device migration. We have treated 135 patients with the Hunter IVC balloon. Sick patients tolerate the procedure, and it is highly effective in preventing pulmonary embolism. Leg morbidity is acceptable, parallels the extent of the phlebitis, and is lessened by leg care and simultaneous anticoagulation therapy. Long-term results with follow-up to 13 years are excellent.