A Greenfield filter placed in the inferior vena cava to intercept deep vein thromboses from the lower extremity may be associated with complications, some of which can be fatal. An autopsy performed on a patient with a Greenfield filter should be done carefully in order to document potentially significant changes.
Potentially fatal complications of a Greenfield filter:
(1) perforation of the inferior vena cava with massive hemorrhage
(2) acute tricuspid insufficiency
(3) perforation of the right ventricle
(4) migration into a pulmonary artery (pulmonary embolism-like)
(5) ventricular arrhythmia
Since the filter is no longer intercepting thromboemboli the patient may be at risk for massive pulmonary embolism as well.
In the cases reported by Shmuter et al the filters moved after large thrombi impacted against them. The thrombi were the immediate cause for filter failure (by increasing the diameter of the inferior cava, by pushing against the filter, etc). In such cases the authors argue that death should be classified as being of natural causes.
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