Effective Use of Inferior Vena Cava Filters in High-risk Morbidly Obese Patients Undergoing Bariatric Surgery

Tec Chong, MD FACS, Suma Sangisetty, MD, Siva Vithianathan, MD FACS. Brown Alpert School of Medicine



Obesity is an independent risk factor for venous thromboemolic events (VTE), including pulmonary embolism (PE), which is the leading cause of death postoperatively from bariatric surgery. Retrievable inferior vena cava (IVC) filters have been shown to prevent VTE, and have a low morbidity profile when retrieved. We developed a protocol for placement of IVC filters in high-risk morbidly obese patients undergoing bariatric surgery and post-operative retrieval of the IVC filter.

Patients undergoing bariatric surgery were chosen for IVC filter placement based on the presence of one or more high-risk characteristics for VTE; BMI>50, non-ambulatory or impaired ambulatory status, prior history or family history of VTE, pulmonary hypertension, and hypercoagulable state. Retrievable IVC filters were inserted within 14 days of bariatric surgery. IVC filters were retrieved at 4 to 6 weeks after bariatric surgery or when the patient was fully ambulating.

IVC filter placement was performed in 21 patients. Their average BMI was 51±7.6. Route of insertion of the IVC filters was right internal jugular vein in 10 patients, right common femoral vein in 10 patients and left common femoral vein in one patient. Average indwelling time for the filters was 64±22 days. 16 patients had their IVC filters removed post-operatively (76%). Two patients were lost to follow-up. One patient requires increased mobility and one patient is awaiting filter removal. No patients had a venous thromboembolic event.

IVC filter placement in high-risk morbidly obese patients undergoing bariatric surgery is a safe and effective form of prophylaxis against VTE.

Session Number: Poster – Poster Presentations
Program Number: P417
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