Suprarenal placement of vena caval filters: indications, techniques, and results.

Preferred treatment for thromboembolism when heparin fails or is contraindicated is infrarenal inferior vena cava (IVC) interruption. In the present study suprarenal Greenfield filters were placed in 11 patients in whom routine infrarenal IVC interruption would have been inadequate therapy. As identified by IVC venography, nine patients, including two patients with renal vein thrombi and proteinuria, had partially attached IVC thrombi extending to or above the orifices of the renal veins. One patient had multiple life-threatening pulmonary emboli (PE) on anticoagulation therapy without a known source of emboli and a large patent ovarian vein, and another had an ovarian vein thrombus. Five patients (45%) had a contraindication to heparin therapy, and five (45%) had recurrent PE on anticoagulants. In follow-up (range 3 to 26 months, mean 12.3 months) there has been no documented or suspected recurrent PE, change in renal function, or peripheral edema. There were two deaths secondary to malignancy. IVC patency was demonstrated in all patients studied. Eight patients continue to receive anticoagulants. Based on our clinical experience, our data suggest that suprarenal filter placement is indicated in the following situations: (1) recurrent thromboemboli despite anticoagulation therapy with IVC thrombi extending to or above the renal veins, renal vein thrombosis, previous IVC interruption, or a large patent left ovarian vein or (2) documented perirenal IVC thrombi when anticoagulation therapy is contraindicated. The results of this study indicate that when thromboemboli originate at or above the level of the renal veins in the IVC, suprarenal IVC filter placement is effective therapy.