肺塞栓症に対するGreenfield vena caval filterの使用経験

Clinical experience with Greenfield vena caval filter

　Greenfield vena caval filterは，肺塞椎症を防止するために経静脈的に下大静脈に留置するフィルターで，下大静脈の開存性を保ちながら塞栓症を防止できるようデザインされている（図1）。我々は，急性および慢性肺塞栓症3例に，このフィルターを用いる機会をもったので，客症例の経過とフィルター留置手技に関する問題点につき報告する。

We used three Greenfield filters for a case of acute and two cases of chronic pulmonary embolism.

Case 1. A 43 years old man developed acute pulmo-nary embolism due to deep vein thrombus. In spite of anticoagulant therapy, he got another severe at-tack of pulmonary embolism. So filter insertion was indicated to him.

Case 2. A 60 years old woman admitted to our hospital because of gradually increasing dyspnea and congestive heart failure. Lung scan revealed multiple pulmonary embolism. Although we could not find the source of emboli, considering her poor cardiopul-monary functional reservation, we decided to use the Greenfield filter.

Case 3. A 51 years old man had edema and pain of his leg due to deep vein thrombus, and pulmonary arteriography revealed thrombotic occulusion of right middle and lower lobe pulmonary arteries. In this case we used the filter prophylactically.

All three patients were well post operativelly for 6 to 12 months, and signs of complications like venous occulusion have not yet been seen. The filters were inserted relatively easily and safely. So prophylactic use of the Greenfield filter under careful consideration may be acceptable.