title: Inferior vena cava filter placement for pulmonary embolism risk reduction in super morbidly obese undergoing bariatric surgery.
abstract: BACKGROUND
  Pulmonary embolism (PE) is a leading cause of mortality after bariatric surgery. We evaluated inferior vena cava (IVC) filter use for PE risk reduction in high-risk super morbidly obese bariatric surgery patients.
  
  
  METHODS
  IVC filters were inserted according to the patient's risk factors, including immobility, previous deep venous thrombosis (DVT)/PE, venous stasis, and pulmonary compromise. All filters were placed concomitant to bariatric surgery and were placed through a right internal jugular vein access site. We analyzed the prospectively collected data from this cohort and evaluated the incidence of PE and complications.
  
  
  RESULTS
  Since April 2003, 41 patients (12 men and 29 women) with a mean age of 47.3 +/- 10.0 years and body mass index of 64.2 +/- 12 kg/m2 (range 47-105) underwent IVC filter placement. These and all other patients underwent standard DVT/PE risk reduction measures. All IVC filter patients had one or more significant risk factors for thromboembolic events. No instances of PE were documented, although 1 patient experienced DVT, and no immediate or late complications related to filter placement occurred. One patient, with a body mass index of 105 kg/m2, died secondary to rhabdomyolysis after an extended procedure. The average filter placement time was 34.3 +/- 9 minutes.
  
  
  CONCLUSIONS
  IVC filter placement for PE risk reduction is safe and feasible in the super morbidly obese. Our data have shown that the filters can be placed expeditiously and with minimal morbidity concomitant with bariatric surgery. In this limited series, IVC filter placement was associated with no PE. Additional studies are needed to confirm the efficacy of IVC filter placement for PE risk reduction and related mortality in the super morbidly obese.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-3280, USA. christainomaha@yahoo.com
authors.forename: Christa M
authors.initials: CM
authors.lastname: Trigilio-Black
authors.forename: Chad D
authors.initials: CD
authors.lastname: Ringley
authors.forename: Corrigan L
authors.initials: CL
authors.lastname: McBride
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Sorensen
authors.forename: Jon S
authors.initials: JS
authors.lastname: Thompson
authors.forename: G Matthew
authors.initials: GM
authors.lastname: Longo
authors.forename: Iraklis I
authors.initials: II
authors.lastname: Pipinos
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johanning
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011322:Primary Prevention; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior