Percutaneous retrieval of Kimray-Greenfield filter from right atrium and placement in inferior vena cava

Inadvertent placement of a Kimray-Greenfield filter into the right side of the heart occurred in the operating room. With the use of intraoperative fluoroscopy while the patient remained under general anesthesia, the filter was extracted and successfully placed in the inferior vena cava. This was accomplished with standard percutaneous catheter techniques from the femoral route.     

Superior vena caval placement of a Kimray-Greenfield filter

Kimray-Greenfield filters placed in the inferior vena cava have been shown effective for prophylaxis against pulmonary embolism from lower extremity or pelvic thrombi. Percutaneous filter placement in the superior vena cava is described in a patient with pulmonary embolism and upper extremity thrombosis in whom anticoagulative therapy was contraindicated.     

Percutaneous transfemoral placement of the Kimray-Greenfield vena cava filter

In 109 patients in whom inferior vena caval interruption was indicated to prevent pulmonary embolism, Kimray-Greenfield (K-G) filters were inserted from a percutaneous transfemoral approach, 94 from the right common femoral vein and 15 from the left common femoral vein. All attempts at transfemoral filter insertion were successful except in two patients in whom a left common femoral approach was used. No complications occurred during insertion. In four patients, clinical evidence of femoral vein thrombosis ensued within 48 hours of filter insertion. There were no complications related to filter migration, and in 97% of patients the alignment was satisfactory. The percutaneous transfemoral route is a rapid and effective method for inserting K-G filters. The most frequent postinsertion complication was femoral vein thrombosis (ten patients), but only two patients suffered permanent sequelae.     

Percutaneous Kimray-Greenfield filter placement by femoral vein puncture

Percutaneous placement of the Kimray-Greenfield vena cava filter was successfully performed in 12 consecutive patients, 10 from the right femoral vein, one from the left femoral vein, and one from the right internal jugular vein. Tract dilatation to allow placement of a 24-French sheath was easily performed and well tolerated. There was no occurrence of puncture site hematoma, significant blood loss, or postprocedural femoral vein thrombophlebitis. Percutaneous femoral vein approach is as effective as right internal jugular vein approach. The dependence on surgically obtained access for Kimray-Greenfield filter placement is no longer absolute.     

经皮取出右房内13.5F双腔血透导管1例

1 临床资料 患者女,82岁.因“糖尿病、尿毒症伴急性左心衰竭”而收治入院.经急症颈静脉置临时血透导管(Mahurkar 13.5 F/4.5 mm×13.5 cm,美国科惠公司制造)进行血液透析治疗,后患者心功能明显好转.规律透析治疗2个月时,因临时血透导管动静脉端接口处不慎损坏,在我院手术室拟更换永久血透导管.稍拔出导管,同定导管,固定处远端剪断导管.在拔出静脉内导管段时,由于操作不慎,整个导管进入颈内静脉,而无法取出.     

Greenfield filter: percutaneous placement in 50 patients

Greenfield filters for prevention of pulmonary emboli may be placed in the inferior vena cava by surgical cutdown or by percutaneous insertion through the femoral or jugular veins. We evaluated the use of the percutaneous techniques 52 times in 50 patients. The right femoral vein was used in 37 of the procedures, the right internal jugular vein in 12, and the left femoral vein in three. Twenty-two patients had altered coagulation factors: 11 were receiving heparin, four were receiving warfarin sodium, six had hepatic cirrhosis, and one had disseminated intravascular coagulation and had been receiving warfarin sodium. Filter placement was successful in 51 of 52 procedures. In the unsuccessful case, placement was attempted via the left femoral vein; the carrier could not be advanced from the common iliac vein to the inferior vena cava. This patient required surgical occlusion of the cava. There was one major complication, a hematoma in the right side of the groin that required transfusion. This occurred in the patient with disseminated intravascular coagulation who had extensive scarring from multiple previous vascular surgical procedures. Two patients required second filters because of severe angulation of the filter found 1 and 4 days after implantation. Clinical thrombosis of the femoral vein after femoral vein access occurred in two (5%) of 40 patients and was proved by venogram in one. Our experience shows that the percutaneous method is highly successful and suggests that this technique should be the primary method for filter placement in the inferior vena cava.     

Successful percutaneous retrieval of an inferior vena cava filter migrating to the right ventricle in a bariatric patient

The use of an inferior vena cava filter has an important role in the management of patients who are at high risk for development of pulmonary embolism. Migration is a rare but known complication of inferior vena cava filter placement. We herein describe a case of a prophylactic retrievable vena cava filter migrating to the right ventricle in a bariatric patient. The filter was retrieved percutaneously by transjugular approach and the patient did well postoperatively. A review of the current literature is given.     

CT evaluation of Kimray-Greenfield filter complications

CT is a simple noninvasive method for evaluating inferior-vena-caval filters. The cross-sectional format offers an advantage over other techniques because the pericaval region is also evaluated. Thirteen patients scanned for localization and suspected complications of the Kimray-Greenfield filter revealed pericaval organ injury, retroperitoneal hematoma, and filter perforation. These events could only be inferred indirectly from other imaging techniques. In addition, CT easily demonstrated the position of the filter within the inferior vena cava and the relation of the filter to the renal veins. CT is a valuable adjunct to radiography, echography, and contrast venography in monitoring patients with Kimray-Greenfield filters.