Abstract
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/m2. 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.
Similar content being viewed by others
References
Ogden CL et al (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555
ASMBS. Bariatric Surgery Fact Sheet 2007. Available via http://www.asbs.org/Newsite07/media/fact-sheet1_bariatric-surgery.pdf
Rocha AT et al (2006) Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Obes Surg 16:1645–1655
Carmody BJ et al (2006) Pulmonary embolism complicating bariatric surgery: detailed analysis of a single institution’s 24-year experience. J Am Coll Surg 203:831–837
Gargiulo NJ III et al (2007) The incidence of pulmonary embolism in open versus laparoscopic gastric bypass. Ann Vasc Surg 21:556–559
Goldhaber SZ et al (1997) A prospective study of risk factors for pulmonary embolism in women. JAMA 277:642–645
Cotter SA et al (2005) Efficacy of venous thromboembolism prophylaxis in morbidly obese patients undergoing gastric bypass surgery. Obes Surg 15:1316–1320
Gonzalez QH et al (2004) Incidence of clinically evident deep venous thrombosis after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 18:1082–1084
Hamad GG, Choban PS (2005) Enoxaparin for thromboprophylaxis in morbidly obese patients undergoing bariatric surgery: findings of the prophylaxis against VTE outcomes in bariatric surgery patients receiving enoxaparin (PROBE) study. Obes Surg 15:1368–1374
Miller MT, Rovito PF (2004) An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg 14:731–737
Frezza EE, Wachtel MS (2006) A simple venous thromboembolism prophylaxis protocol for patients undergoing bariatric surgery. Obesity (Silver Spring) 14:1961–1965
Kothari SN, Lambert PJ, Mathiason MA (2007) Best Poster Award. A comparison of thromboembolic and bleeding events following laparoscopic gastric bypass in patients treated with prophylactic regimens of unfractionated heparin or enoxaparin. Am J Surg 194:709–711
Shepherd MF, Rosborough TK, Schwartz ML (2003) Heparin thromboprophylaxis in gastric bypass surgery. Obes Surg 13:249–253
Gargiulo NJ III et al (2006) Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures. J Vasc Surg 44:1301–1305
Prystowsky JB et al (2005) Prospective analysis of the incidence of deep venous thrombosis in bariatric surgery patients. Surgery 138:759–765
Ferrell A, Byrne TK, Robison JG (2004) Placement of inferior vena cava filters in bariatric surgical patients: possible indications and technical considerations. Obes Surg 14:738–743
Piano G et al (2007) Safety, feasibility, and outcome of retrievable vena cava filters in high-risk surgical patients. J Vasc Surg 45:784–788
Trigilio-Black CM et al (2007) Inferior vena cava filter placement for pulmonary embolism risk reduction in super morbidly obese undergoing bariatric surgery. Surg Obes Relat Dis 3:461–464
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vaziri, K., Bhanot, P., Hungness, E.S. et al. Retrievable inferior vena cava filters in high-risk patients undergoing bariatric surgery. Surg Endosc 23, 2203–2207 (2009). https://doi.org/10.1007/s00464-008-0307-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0307-0