title: Venous insufficiency and thromboembolic disease in bariatric surgery patients.
abstract: BACKGROUND
  Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism.
  
  
  OBJECTIVE
  To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease.
  
  
  METHODS
  Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrasonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrasonography search for venous insufficiency and deep venous thrombosis.
  
  
  RESULTS
  Between March 2007 and December 2009, 95 patient candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism.
  
  
  CONCLUSIONS
  No relation between BMI, CEAP classification and venous ultrasonographic findings were found. Although prophylaxis was used in all patients, the incidence of post-operative distal venous thrombosis was considerably high.
authors: Hospital da Beneficencia Portuguesa, Serviço de Cirurgia Vascular Integrada, São Paulo.
authors: Bonno van
authors: Bv
authors: Bellen
authors: Ivan de Barros
authors: Ide B
authors: Godoy
authors: Andrea Almeida
authors: AA
authors: Reis
authors: Pedro
authors: P
authors: Bertevello
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D011300:Preoperative Care; D011446:Prospective Studies; D014689:Venous Insufficiency / Q000150:complications*; D054556:Venous Thromboembolism / Q000209:etiology*