Safety and efficacy of intravascular ultrasound-guided inferior vena cava filter in super obese bariatric patients.
BACKGROUND
The morbidly obese (body mass index >40 kg/m(2)) are at significant risk of postoperative venous thromboembolism (VTE). Pulmonary embolism is the leading cause of death after Roux-en-Y gastric bypass, approximating .5%. Because of the technical limitations with fluoroscopy and table weight limits, it has been our practice at our university-based bariatric center to offer intravascular ultrasound (IVUS)-guided inferior vena cava filter (IVCF) placement at Roux-en-Y gastric bypass to patients with a history of VTE, hypercoagulable state, or profound immobility.


METHODS
The hospital and outpatient records of all 594 patients who underwent Roux-en-Y gastric bypass from January 1, 2004 to October 31, 2006 were reviewed. The patients who had undergone concurrent IVUS-guided IVCF placement were selected. The co-morbidities, outcomes, and complications were recorded.


RESULTS
Of the 594 patients, 31 (mean body mass index 71.2 +/- 2.96 kg/m(2)) had undergone concurrent IVUS-guided IVCF placement. The indications included a history of VTE (n = 5), a known hypercoagulable state (n = 2), and profound immobility (n = 25). The technical success rate was 96.8%. One filter was malpositioned in the iliac vein. No catheter site complications occurred. A ventilation/perfusion scan and computed tomography scan each detected pulmonary embolism in 2 surviving patients within 2 months postoperatively. Two patients died, 1 on postoperative day 8 and 1 on postoperative day 15 (6.4%). The mean follow-up time was 262.8 +/- 37.3 days. Autopsy excluded VTE or IVCF-related issues as the cause of death in both patients.


CONCLUSIONS
These results suggest the efficacy of IVUS-guided IVCF placement in preventing mortality from pulmonary embolism in high-risk bariatric patients. IVUS-guided IVCF placement can be safely performed with an excellent success rate in high-risk patients who would not otherwise be candidates for intervention because of the technical limitations of fluoroscopy.
Department of Surgery, Section of Bariatric and Minimally Invasive Surgery and Section of Vascular Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA.
Clark M
CM
Kardys
Michael C
MC
Stoner
Mark L
ML
Manwaring
Michael
M
Barker
Kenneth G
KG
Macdonald
John R
JR
Pender
William H
WH
Chapman
D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019919:Prosthesis Implantation; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D016306:Vena Cava Filters