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Prophylactic Inferior Vena Cava Filters in High-Risk Bariatric Surgery

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Abstract

Background

Bariatric patients are at significant risk for venous thromboembolism (VTE) and a subset may benefit from retrievable inferior vena cava filters (rIVCFs). Optimal VTE prophylaxis and a consensus on factors which make bariatric patients high risk have not been established. This study describes our experience with the use of rIVCFs in combination with chemoprophylaxis for high-risk bariatric surgery patients.

Methods

A retrospective review was performed of high-risk patients bariatric surgery patients. Patients with a hypercoaguable condition, prior history of VTE, body mass index (BMI) > 55 kg/m2, and severe immobility were considered high risk. Patients underwent rIVCF placement and standard chemoprophylaxis. A venogram was performed at retrieval.

Results

Forty-four patients, age of 48 ± 12 years and BMI of 58.4 ± 9.4 kg/m2 underwent gastric bypass with rIVCF placement. Follow-up was 204 days. One patient had a preoperative deep venous thrombosis (DVT). All patients received chemoprophylaxis and rIVCF placement. Indications for rIVCF were BMI (68%), prior VTE (30%), and immobility (2%). The operation was performed laparoscopically in all patients, and the mean operative time was 106.1 ± 21.6 min and length of stay was 3.1 ± 1.2 days. Postoperative venous duplex revealed two DVTs (5%). Retrieval was successful in 28 patients. No significant thrombus was found on venogram. Two minor complications of filter placement occurred. One mortality occurred due to MI, and no pulmonary emboli were clinically evident.

Conclusions

rIVCFs in our cohort of high-risk bariatric surgery patients was associated with an acceptably low incidence of DVT (5%) and no clinically evident PE. Despite safe removal after long dwell times, previous data suggest that rIVCFs are associated with a higher incidence of VTE. Thus, filters, if placed, should be removed once the risk of VTE has passed. Larger multicenter studies are needed to truly identify long-term safety and efficacy of rIVCFs.

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Conflicts of interest

Drs. Vaziri, Lee, Brody, Sarin, Ignacio, Chun, and Lin have no financial ties or conflicts of interest to disclose. Mr. Watson and Ms. Harper have no financial ties or conflicts of interest to disclose. Dr. Venbrux has received honoraria for lectures from Bard, Cook, Cordis, and Rex medical. Dr. Venbrux is also a consultant for Bard Peripheral Vascular

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Authors and Affiliations

  1. Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA

    Khashayar Vaziri, J. Devin Watson, Juliet Lee, Fredrick J. Brody & Paul P. Lin

  2. Department Interventional Radiology, The George Washington University Medical Center, Washington, DC, USA

    Amy P. Harper, Shawn Sarin, Elizabeth A. Ignacio, Albert Chun & Anthony C. Venbrux

Authors
  1. Khashayar Vaziri
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  2. J. Devin Watson
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  3. Amy P. Harper
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  4. Juliet Lee
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  5. Fredrick J. Brody
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  6. Shawn Sarin
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  7. Elizabeth A. Ignacio
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  8. Albert Chun
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  9. Anthony C. Venbrux
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  10. Paul P. Lin
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Correspondence to Khashayar Vaziri.

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Vaziri, K., Devin Watson, J., Harper, A.P. et al. Prophylactic Inferior Vena Cava Filters in High-Risk Bariatric Surgery. OBES SURG 21, 1580–1584 (2011). https://doi.org/10.1007/s11695-010-0301-1

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  • DOI: https://doi.org/10.1007/s11695-010-0301-1

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