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

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 obesity Bariatric surgery Gastric bypass Vena cava filters Pulmonary embolism CT venography Thrombophilia 

References

  1. 1.
    Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–55.PubMedCrossRefGoogle Scholar
  2. 2.
    O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program. Ann Intern Med 2006;144:625–33.PubMedGoogle Scholar
  3. 3.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142(7):547–59.PubMedGoogle Scholar
  4. 4.
    Colquitt J, Clegg A, Loveman E, et al. Surgery for morbid obesity. Cochrane Database Syst Rev 2005;4(4):CD003641.PubMedGoogle Scholar
  5. 5.
    Nguyen NT, Root J, Zainabadi K, et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 2005;140(12):1198–202.PubMedCrossRefGoogle Scholar
  6. 6.
    ASMBS. The Story of Surgery for Obesity. http://www.asbs.org/html/patients/bypass.html. Accessed June 6, 2008.
  7. 7.
    Podnos YD, Jimenez JC, Wilson SE, et al. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 2003;138(9):957–61.PubMedCrossRefGoogle Scholar
  8. 8.
    Melinek J, Livingston E, Cortina G, et al. Autopsy findings following gastric bypass surgery for morbid obesity. Arch Pathol Lab Med 2002;126(9):1091–5. Sep.PubMedGoogle Scholar
  9. 9.
    Fernandez AZ Jr, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004;239(5):698–702.PubMedCrossRefGoogle Scholar
  10. 10.
    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126(3 Suppl):338S–400S.PubMedCrossRefGoogle Scholar
  11. 11.
    Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg 2000;10(1):7–13. Feb.PubMedCrossRefGoogle Scholar
  12. 12.
    Schuster R, Hagedorn JC, Curet MJ, et al. Retrievable inferior vena cava filters may be safely applied in gastric bypass surgery. Surg Endosc 2007;12:2277–9.CrossRefGoogle Scholar
  13. 13.
    Trigilio-Black CM, Ringley CD, McBride CL, et al. Inferior vena cava filter placement for pulmonary embolism risk reduction in super morbidly obese undergoing bariatric surgery. Surg Obes Relat Dis 2007;3(4):461–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Martin MJ (ed) In: Obeid FN, Bowling WM, Fike JS, et al. Efficacy of prophylactic inferior vena cava filter placement in bariatric surgery. Surg Obes Relat Dis 2007;3(6):606–10. Nov–Dec.Google Scholar
  15. 15.
    Sugerman HJ, Sugerman EL, Wolfe L, Kellum JM Jr, Schweitzer MA, DeMaria EJ. Risks and benefits of gastric bypass in morbidly obese patients with severe venous stasis disease. Ann Surg 2001;234(1):41–6. Jul.PubMedCrossRefGoogle Scholar
  16. 16.
    Sapala JA, Wood MH, Schuhknecht MP, et al. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg 2003;13(6):819–25. Dec.PubMedCrossRefGoogle Scholar
  17. 17.
    Overby DW, Farrell TM. Prophylactic placement of removable inferior vena cava filters in patients undergoing gastric bypass for morbid obesity. Surg Endosc 2007;21(Suppl 13):S341.Google Scholar
  18. 18.
    Overby DW, Colton K, Stavas JM, et al. Central venous line placement prior to gastric bypass improves O.R. efficiency. Surg Obes Relat Dis 2008;4(3):312–3.CrossRefGoogle Scholar

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

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