Insertion Technique and Placement Site for Greenfield Filters: Does it Make Any Difference?

Abstract

The clinical outcome and complication rates related to the choice of technique and insertion site in the placement of a Greenfield filter (GFF) is still controversial. Moreover, there is no consensus as to which technique and placement site produces the best outcome. This study evaluated the charts of 364 patients who received GFFs during a 5-year period. Seventy-one filters were placed surgically and 293 were placed percutaneously in the operating room by general and vascular surgeons. Seventy-eight were placed using the femoral approach and 296 were placed using the jugular approach. Demographics were recorded as well as preoperative, intraoperative, and postoperative variables. All immediate complications were examined including failure of the GFF to open, suboptimal placement, multiple attempts at placement, abandoned procedures, guidewire related difficulties, hematoma, bleeding, phlegmasia cerulea dolens, pneumothorax, arrhythmia, and death. There was no statistically significant difference between complications derived from surgical placement versus percutaneous placement. There were no statistically significant differences among variables based on jugular versus femoral placement. There was a statistically significant difference in the time required for the percutaneous placement versus the open surgical procedure (33 ± 28 min. vs 45 ± 27 min., p < 0.05). These findings suggest that the technique and site of the GFF insertion can be left to the discretion of the surgeon based on each patient's profile.