INFERIOR VENA-CAVA INTERRUPTION FOR THE PREVENTION OF PULMONARY EMBOLI - ADVANTAGES, DISADVANTAGES, AND COMPLICATIONS

Pulmonary embolism (PE) in high-risk patients is minimized by inferior vena caval interruption by ligation, plication/clipping, intraluminal filters, or intraluminal balloons. Vena caval filter implantation is the least traumatic of all surgical implantation is the least traumatic of all surgical methods of preventing PE. These nonocclusive methods are preferred to minimize the possible sequelae of venous insufficiency. The prevention of septic emboli requires complete ligation of the inferior vena cava (IVC). The transvenous approach to IVC interruption by intraluminal filter is particularly useful in severely ill patients. The Kim-Ray Greenfield filters are at present the most frequently used modalities for prevention of fatal PE when intervention is required. In a large series of patients who have had the Greenfield filer implanted, there has been an operative mortality of less than 1%, with an incidence of recurrent emboli of less than 2%, and an incidence of venous stasis sequelae of approximately 20%. In general, this device has greater ease and flexibility of placement with lower mortality and morbidity rates.