Retrievable Inferior Vena Cava Filters in High Risk Patients Undergoing Bariatric Surgery

Introduction: Placement of retrievable inferior vena cava filters (IVCF) may be beneficial in high risk morbidly obese patients undergoing bariatric procedures. Bariatric surgery patients with a prior history of venous thromboembolism (VTE) are at high risk for postoperative recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE). Methods: A prospective database of morbidly obese patients undergoing a bariatric procedure was studied from April 2003 to May 2007. 791 patients underwent bariatric surgery of which 30 (4%) had a prior history of VTE. These patients underwent pre-operative venous duplex and concurrent placement of a retrievable IVCF. Patient demographics and clinical outcomes were examined. Results: The 30 patients had a mean age of 49±8 years, 12 (40%) were male with a mean BMI of 50±8 kg/m2. 16 (53%) underwent laparoscopic roux-en-y gastric bypass, 10 (33%) laparoscopic adjustable gastric band, and 4 (14%) open roux-en-y gastric bypass. The mean operative time including IVCF placement was 162±66 minutes. Indications for IVCF placement were DVT in 20 (67%) and PE in 10 (33%) patients. All patients had successful IVCF placement along with standard peri-operative VTE prophylaxis. 29 (97%) patients had a follow up ultrasound on mean post-operative day (POD) 19±25. 6 (21%) patients had recurrent DVT confirmed by ultrasound. 27 (90%) patients underwent a follow up venogram and 4 (15%) had significant thrombus in the IVCF. Overall, retrieval was successful in 21 (70%) patients. 9 (30%) patients did not undergo retrieval, 4 had significant thrombus in the filter, 4 had an above knee DVT, and 1 due to technical reasons at the time of retrieval. 1 patient had a complication of retrieval with a DVT at the venous access site. No PE or mortality occurred. 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 1 complication. Concurrent IVCF placement is safe, feasible, and an effective preventative measure in high risk morbidly obese patients. We recommend the use of retrievable IVCFs in conjunction with standard VTE prophylaxis in this patient population.

Session: Podium Presentation

Program Number: S009

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