Three year experience with percutaneous introduction of inferior vena cava filter.

Fifteen patients with recurrent pulmonary embolism were treated with a Mobin-Uddin umbrella filter (UF) introduced percutaneously via femoral vein. There were not technical difficulties, bleeding, or migration of the UF. The incidence of lower extremity edema or phlebitis was not higher than in patients with transjugular application of the UF or in patients with surgical inferior vena cava clipping. Two patients had fatal recurrent pulmonary embolism: in one of them the UF was positioned correctly in the vicinityof the renal veins; in the second the UF was placed too low and a large clot may have formed proximal to the UF. The transfemoral approach of the UF insetion represents a significant simplication of the inferior vena caval interruption, but it can only be used if thrombi are excluded by venography in the iliac vein and inferior vena cava. The UF should be placed as close as possible to the orifices of the renal veins to prevent a thrombus formation proximal to the filter.