Greenfield Filter Migration

An 82-year-old woman was admitted to the hospital with severe dilated cardiomyopathy. The condition was alcohol-induced and had been diagnosed about 12 years earlier. The patient was taking angiotensin-converting enzyme inhibitors and diuretics.

Drs Salama Salama, Gamil Kostandy, and Bruce Sosler of New York Methodist Hospital in Brooklyn explain that while in the hospital, the patient experienced multiple episodes of deep venous thrombosis. A history of acute gastrointestinal tract bleeding precluded the use of heparin. A Greenfield filter was placed percutaneously into the inferior vena cava (IVC).

Forty-eight hours after the filter insertion and while still in the cardiac care unit, the patient became hypotensive and acute shortness of breath developed. A chest film demonstrated the migration of the Greenfield filter into the right atrium, which culminated in her death.

Drs Salama, Kostandy, and Sosler comment that migration of a Greenfield filter is rare but can occur when there is a mismatch between the diameter of the filter and the width of the IVC. The patient's congestive heart failure secondary to her long-standing cardiomyopathy might have caused the widened IVC. Had the woman been more hemodynamically stable, percutaneous removal of the filter could have been attempted.¹

REFERENCES:1. Deutsch LS. Percutaneous removal of intracardiac Greenfield vena caval filter. AJR. 1988;151:677-679.