Obesity Surgery

, Volume 19, Issue 4, pp 451–455

Risk-Group Targeted Inferior Vena Cava Filter Placement in Gastric Bypass Patients

  • D. Wayne Overby
  • Geoffrey P. Kohn
  • Mitchell A. Cahan
  • Robert G. Dixon
  • Joseph M. Stavas
  • Stephan Moll
  • Charles T. Burke
  • Karen J. Colton
  • Timothy M. Farrell
Research Article

DOI: 10.1007/s11695-008-9794-2

Cite this article as:
Overby, D.W., Kohn, G.P., Cahan, M.A. et al. OBES SURG (2009) 19: 451. doi:10.1007/s11695-008-9794-2
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Abstract

Background

Despite a growing body of evidence guiding appropriate perioperative thromboprophylaxis in the general population, few data direct strategies to reduce deep venous thrombosis (DVT) and pulmonary embolism (PE) in the morbidly obese. We have implemented a novel protocol for venous thromboembolism (VTE) risk stratification in Roux-en-Y gastric bypass (RYGB) candidates at our institution, which augments clinical assessment with screening for thrombophilias, to guide retrievable inferior vena cava (IVC) filter utilization.

Methods

A retrospective review of prospectively collected data from patients who underwent primary RYGB between 2001 and 2008 at the University of North Carolina at Chapel Hill was completed. During that time, clinical assessment of VTE risk was amplified by focused plasma screening for common thrombophilias (factors VIII, IX, and XI, d-dimer, fibrinogen). Preoperative prophylactic IVC filters were offered to high-risk patients. The database was reviewed for perioperative DVTs, PEs, and filter-related complications.

Results

Of 330 patients, in 162 attempts, 160 had prophylactic IVC filters placed with four complications overall (2.47%). No patient had symptoms of PE during the planned 6-week filter period, though one had a PE occur immediately after filter removal (0.63%); in contrast, five of 170 patients (2.94%) without prophylactic IVC filters presented with symptomatic PE (p = 0.216). In total, 147 (91.88%) prophylactic filters were removed.

Conclusions

Risk-group targeted prophylactic inferior vena cava filter placement prior to RYGB is safe with a trend towards reduced occurrence of PE.

Keywords

Morbid obesityBariatric surgeryGastric bypassVena cava filtersPulmonary embolismCT venographyThrombophilia

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • D. Wayne Overby
    • 1
  • Geoffrey P. Kohn
    • 1
  • Mitchell A. Cahan
    • 1
  • Robert G. Dixon
    • 2
  • Joseph M. Stavas
    • 2
  • Stephan Moll
    • 3
  • Charles T. Burke
    • 2
  • Karen J. Colton
    • 1
  • Timothy M. Farrell
    • 1
  1. 1.Department of SurgeryUniversity of North CarolinaChapel HillUSA
  2. 2.Department of RadiologyUniversity of North CarolinaChapel HillUSA
  3. 3.Department of MedicineUniversity of North CarolinaChapel HillUSA