Use of a new removable vena cava filter in order to prevent pulmonary emblism in patients submitted to thrombolysis

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Abstract
The authors present a removable vena cava filter that may be introduced percutaneously, is atraumatic to the venous wall, and permits the simultaneous use of thrombolytk therapy. Sixty-five patients were studied: 42 cases of pulmonary embolism with threatening venous thrombosis; 23 cases of phlebitis associated with an ilio-caval thrombus without pulmonary embolism. The filter was introduced 38 timesfemor ally and 27 times by a jugular approach. In 16 cases (24-6%) clots broke loose, were effectively caught by the filter, and were progressively dissolved during thrombolytic therapy. The filter remained in place on average 4-5 ± 1-2 days. The filter was removed in all cases without provoking the recurrence of pulmonary embolism. Two deaths, not related to pulmonary embolism, occurred during hospitalization. Phlebography, performed in all cases before and after treatment, showed a significant decrease of the phlebographic score (10.88±0.82 vs 6.77±0.86, P−1l of haemoglobin was lost by 15.38% of patients. All patients were follow ed-up for a mean of 712± 1.3 months; in no case was there any clinical recurrence of pulmonary embolism. Thus this device allows an effective temporary filtering of the vena cava. Thrombolytic therapy, in association with the retrievable filter is possible with favourable results at the cost of an increased risk of haemorrhage.