Retrievable inferior vena cava filters in high-risk patients undergoing bariatric surgery

Khashayar Vaziri, Parag Bhanot, Eric S Hungness, Mark D Morasch, Jay B Prystowsky, Alexander P Nagle
Surgical Endoscopy 2009, 23 (10): 2203-7

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.

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