Preoperative placement of retreivable inferior vena cava filters in bariatric surgery

Denis Halmi, Evgeni Kolesnikov
Surgery for Obesity and Related Diseases 2007, 3 (6): 602-5

BACKGROUND: Postoperative pulmonary embolism (PE) is a major source of mortality after bariatric surgery. In conjunction with pharmacologic thromboprophylaxis, lower extremity pneumatic compression devices, and early ambulation, preoperative placement of a retrievable inferior vena cava (IVC) filter may reduce the risk of thromboembolic complications.

METHODS: From June 2003 to October 2005, 652 patients underwent mini-open Roux-en-Y gastric bypass. Of the 652 patients, 557 were women and 95 were men. The mean patient age was 40.7 +/- 3.6 years (range 18-67), mean body mass index was 44.7 +/- 4.6 kg/m(2) (range 35-78), and mean operative time was 60.2 +/- 5.3 minutes (range 42-79). The high-risk PE group consisted of 27 patients (4.1%; 9 men and 18 women) who received preoperative retrievable IVC filters placed by the interventional radiology staff 2 hours before bypass surgery. Their mean age was 47 +/- 4.4 years (range 31-66) and mean body mass index 48.7 +/- 4.2 kg/m(2) (range 38-75). The indications for filter placement were previous deep vein thrombosis/PE, thrombophlebitis, a hypercoagulable state, pulmonary hypertension, an inability to ambulate, a body mass index >65 kg/m(2), and the presence of severe sleep apnea. The filters were removed 18.2 +/- 2 days (range 15-21) postoperatively.

RESULTS: All 27 patients who received a prophylactic IVC filter tolerated the procedure well, without major complications. One retrievable filter was not removed because of prolonged hospitalization secondary to small bowel obstruction. No thromboembolic complications occurred in this high-risk group.

CONCLUSION: Preoperative placement of retrievable IVC filters is a safe measure for the prophylaxis of PE in high-risk bariatric patients. The filters can be placed efficiently just before surgery, and most filters can be removed 2-3 weeks postoperatively. Additional investigation is necessary to prove the effectiveness of retrievable IVC filters in bariatric surgery.

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