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Therapeutic and prophylactic vena caval interruption for pulmonary embolism: caval and venous insertion site patency.
- Source :
-
Annals of vascular surgery [Ann Vasc Surg] 1993 Nov; Vol. 7 (6), pp. 561-8. - Publication Year :
- 1993
-
Abstract
- Although anticoagulation remains the treatment of choice for acute pulmonary embolism, vena caval interruption represents an alternative for patients with contraindications and complications or in whom anticoagulation fails. The purpose of this study was to evaluate the effectiveness and safety of two types of caval interruption devices: the original stainless steel Greenfield filter and the Adams-DeWeese clip. Emphasis has been placed on maintaining caval patency with filters and clips and the patency of the femoral vein vs. the jugular vein after filter insertion. We retrospectively reviewed 161 patients who underwent caval interruption (92 filters and 69 clips) for both therapeutic and prophylactic reasons. The operative mortality and morbidity rates were 0% and 3.3% for filter patients and 8.7% and 2.9% for clip patients; no procedure-related mortalities occurred. The late caval patency rate as documented by duplex ultrasonography/venography was 100% for filter patients and 88% for clip patients (p = 0.011). Seven percent of the filter patients and 20% of the clip patients experienced late limb swelling postoperatively (p = 0.05). The incidence of recurrent late pulmonary embolism was 2.5% in the filter group and 1.9% in the clip group. In the filter group, 10% of patients experienced postoperative thrombosis at the femoral vein insertion site and 0% at the jugular vein insertion site. We found that both devices were effective in preventing pulmonary embolism, the filter provided better caval patency than the clip, and the jugular vein had a better patency than the femoral vein after filter insertion.
- Subjects :
- Adult
Aged
Aged, 80 and over
Constriction
Female
Femoral Vein physiology
Follow-Up Studies
Humans
Jugular Veins physiology
Male
Middle Aged
Postoperative Complications mortality
Pulmonary Embolism mortality
Retrospective Studies
Vascular Patency
Pulmonary Embolism prevention & control
Pulmonary Embolism surgery
Vena Cava Filters
Subjects
Details
- Language :
- English
- ISSN :
- 0890-5096
- Volume :
- 7
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Annals of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 8123459
- Full Text :
- https://doi.org/10.1007/BF02000151