Caval interruption methods: comparison of options.

The Stainless Steel and Titanium Greenfield filters, the Venatech filter, and the Bird's nest filter are most commonly used in the United States. A comparison of contemporary experience with these filters along with that of Simon-Nitinol filter is shown in Table 1. The published experience with each device is minimal compared with actual clinical use. The published reports available do not often examine experience with a view toward unbiased and accurate comparison of results. Each filter has an acceptably low rate of recurrent PE, but each has experienced the range of complications associated with vena caval filters or partitions. The reviewed case series are too small and the complication rates too similar for any of the newer designs to claim unequivocal superiority. Except for the Stainless Steel Greenfield filter, comparison is further complicated by the lack of standardized, quantitative follow-up of patients over a period long enough for possible extremity venous complications to be observed. Each of the currently available filters has at least one specific attribute that may recommend it for a particular situation. Detailed and comparable examination of IVC filtration is becoming more important as the indication for and use of these devices increase. Clearly, the search for the perfect device to prevent PE should continue.90 Any filtration device plays only a small role in the overall management of the patient with thromboembolic disease. It is incumbent upon the physician who treats this patient to assume the responsibility for the diagnosis of and long-term follow-up of the underlying disorder. Considerable technical ingenuity and continued evolution of materials and design have propelled the development and number of available vena cava filters for clinical use. Without objective clinical data, many interventional radiologists and surgeons base their filter selection on ease of insertion and device cost. Variable data on safety and effectiveness demand that physicians match the best filter to each patient's particular situation and anatomy. The primary objective of vena cava filtration is to provide a safe and effective device for permanent implantation. If this objective is not kept in sight, quality of care in the management of deep venous thrombosis and/or pulmonary embolus will be lost.