Analysis of inferior venacavography before Greenfield filter placement

The value of routine preoperative inferior venacavography through a femoral approach was assessed in 64 patients who required a Greenfield inferior vena cava filter. Nearly 11% of the patients had an abnormality, for example, duplication of the inferior vena cava, circumaortic renal vein, interrupted or discontinuous inferior vena cava, and so on, requiring an alternate approach to placement. No deaths or complications occurred upon recognition of the anatomic variant before filter placement. In three of the seven abnormalities encountered, adequate visualization and filter placement could only have been accomplished through femoral catheterization. Preoperative cavograms before Greenfield filter placement should be routinely performed using a femoral approach in the absence of contraindications to this technique.