[Cava filter for prevention of lung embolism: is implantation still justified?].

During a period of 11 years operative placement of a Greenfield vena caval filter was planned in 132 patients. The clinical records of these patients were reviewed retrospectively. Main indications for filter placement were pulmonary embolism in patients with deep venous thrombosis in spite of anticoagulation therapy (45%) and patients with contraindications for anticoagulation (40%). Insertion was successful in 117 patients with a failure rate of 14.6% (21 of 143 procedures). Follow-up data were obtained of all 117 patients with inserted filter (6 of them with 2 filters). Physical examination was performed in 67 of 74 patients alive after a mean postoperative period of 57 months (median: 52.5/range: 1-128). In addition, plain abdominal X-ray was available of all patients. CT scans of the abdomen or venacavography studies were obtained in 60 patients. Major complications as recurrent pulmonary embolism (8%), caval thrombosis (13%), penetrations of struts through the caval wall (33%), tilting of filters (25%), migration (5%) and filter fracture (two cases) were observed. In conclusion, indication should be restricted to certain cases with failure of surgical intervention or drug therapy (thrombectomy, lysis, anticoagulation).