Analysis of the Transition to Percutaneous Placement of Greenfield Filters

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Abstract
• To establish whether a transition from surgical to percutaneous placement of Greenfield filters was justified, a review of the safety, efficacy, and cost-effectiveness of the two approaches was conducted. Between 1984 and 1989,168 filters were placed in 169 patients, 48 surgically and 120 percutaneously. Placement was successful in 45 (94%) of the 48 surgical patients and 120 (99%) of the 121 percutaneous patients. Filter misplacement occurred in three (6%) surgical patients and no percutaneous patients. Clinically evident femoral vein thrombosis occurred in only four (5%) of the percutaneous patients, while inferior vena cava thrombosis occurred in three (3%) of the percutaneous patients. One pulmonary embolus occurred after percutaneous filter placement and resulted in death. The cost of percutaneous placement was 58% that of surgical placement. A retrospective review of the experience in our patient population indicates that safety, cost, and ease of insertion make the percutaneous approach the procedure of choice for Greenfield filter placement. (Arch Surg. 1990;125:1550-1553)