Retrievable inferior vena cava filters in high-risk patients undergoing bariatric surgery.
BACKGROUND
Placement of retrievable inferior vena cava filters (rIVCF) may be beneficial in high-risk morbidly obese patients undergoing bariatric procedures. Patients with a previous history of venous thromboembolism (VTE) are at high risk for postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE).


METHODS
A prospective database of bariatric surgery patients was studied from April 2003 to May 2007. A total of 791 patients underwent bariatric procedures, of which 30 (4%) had a previous history of VTE. These patients underwent preoperative venous duplex and concurrent placement of a rIVCF. Patient demographics and clinical outcomes were examined.


RESULTS
Thirty patients (12 (40%) men) had a mean age of 49 +/- 8 years and a mean body mass index of 50 +/- 8 kg/m(2). Sixteen patients (53%) underwent laparoscopic Roux-en-Y gastric bypass, ten (33%) underwent laparoscopic adjustable gastric band, and four (14%) underwent open Roux-en-Y gastric bypass. Mean operative time, including rIVCF placement, was 162 +/- 66 minutes. All patients had successful rIVCF placement with standard perioperative chemoprophylaxis. Twenty-nine patients (97%) had a follow-up ultrasound on postoperative day (POD) 19 +/- 25. Six patients (21%) had recurrent DVT. Twenty-seven patients (90%) underwent a follow-up venogram, and four patients (15%) had significant thrombus in the rIVCF. Retrieval was successful in 21 patients (70%). Nine patients (30%) did not undergo retrieval: four had significant thrombus in the filter, four had an above-knee DVT, and one due to technical reasons. We observed one complication with a DVT at the access site and no PE or mortality.


CONCLUSIONS
We observed a 21% incidence of recurrent DVT and 15% incidence of thrombus in the IVCF, yet no PE occurred. IVCF retrieval was successful in 70% with one complication. Concurrent IVCF placement is safe, feasible, and an effective preventative measure in high-risk morbidly obese patients. We recommend the use of rIVCFs in conjunction with standard VTE prophylaxis in this patient population.
Vaziri
Khashayar
K
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Bhanot
Parag
P
Hungness
Eric S
ES
Morasch
Mark D
MD
Prystowsky
Jay B
JB
Nagle
Alexander P
AP
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D015992:Body Mass Index; D020878:Device Removal; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011859:Radiography; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000517:prevention & control*