Greenfield filter versus Mobin-Uddin umbrella: the continuing quest for the ideal method of vena caval interruption
Cimochowski, G.E.; Evans, R.H.; Zarins, C.K.; Lu, C.T.; DeMeester, T.R.
Journal of Thoracic and Cardiovascular Surgery 79(3): 358-365
1980
ISSN/ISBN: 0022-5223 PMID: 6986511 Document Number: 164935
The Mobin-Uddin umbrella and the Greenfield filter are transvenous methods of interrupting the vena cava with minimal morbidity and operative mortality. The Mobin-Uddin umbrella was used in 65 patients and the Greenfield filter in 32. There was an overall operative mortality rate of 4%, related more to the underlying disease than to the technique of filter or umbrella placement. The recurrence rate for nonfatal pulmonary emboli was 3% with the Mobin-Uddin umbrella and 3.3% with the Greenfield filter. No subsequent lethal embolus was observed with either device. Misplacement occurred with 3 of the Mobin-Uddin umbrellas and 4 of the Greenfield filters. Lethal migration of the transvenous device occurred in 1 patient with a Mobin-Uddin umbrella. Detailed long-term follow-up with vena cavograms or postmortem examination in 40 patients (18 umbrellas and 22 filters) revealed occlusion of the vena cava in 5% with Greenfield filters and in 73% with Mobin-Uddin umbrellas; clot was observed proximal to the umbrella in 1 patient. The Greenfield filter is recommended as the ideal method for protection against thromboembolism because of its ease of insertion under local anesthesia, its high patency rate thereby eliminating stasis sequelae and its protection from lethal thromboembolism.