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European Heart Journal 1990 11(4):334-341;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

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

C. THERY*,, P. ASSEMAN*, N. AMROUNI*, J. BECQUART*, P. PRUVOST*, M. LESENNE*, R. LEGGHE{dagger} and P. MARACHE{dagger}

*service de Soins Intensifs Lille, France
{dagger}Service de Radiologie vasculaire, Höpital Cardiologique Lille, France

Received 17 February 1989; revised 1 June 1989; .

Address for correspondence: CL Thery Service de Soin Inensifs. HöPital Cardiologique, Boulevard du Pr Leclercq, 59037 Lille Cedex, France

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<0001). The same was observed in 40 patients who underwent a pulmonary angiography before and after treatment (Miller index = 1704 ±0.73 vs 5.49 ±0.87, P<00001). After removal of the filter, no sign of pulmonary embolism was detected on lung scan in the 23 patients with ilio-caval thrombus alone. More than 5 g (100ml)–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.

Key Words: Vena cava filter • pulmonary embolism • venous thrombosis


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