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.
Kardys
Clark M
CM
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.
Stoner
Michael C
MC
Manwaring
Mark L
ML
Barker
Michael
M
Macdonald
Kenneth G
KG
Pender
John R
JR
Chapman
William H
WH
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