Reevaluation of indications for percutaneous placement of the Greenfield filter.

In our institution twice as many Greenfield filters were inserted in the year after percutaneous placement was begun as in the previous year when all filters were surgically inserted. Review of the indications for surgical and percutaneous filter placement in our hospital reveals that more filters were inserted percutaneously for all indications except recurrent emboli. The rates of percutaneous and surgical filter insertion for prophylaxis with acute deep venous thrombosis were similar (40% and 42%, respectively) and were higher than the majority of reported filter series because of the large number of high risk patients in our hospital population. In evaluating each patient for risk factors concerning the development of venous thromboembolism, the contraindications to anticoagulation, and the effectiveness and possible complications of anticoagulant therapy, we have defined a much broader range of patients as candidates for Greenfield filter insertion than had been considered in our institution in the past.