The Controversy of Prophylactic IVC Filters in High Risk Patients Undergoing Gastric Bypass Surgery

B Jakub Wilhelm, MD, Aniket K Sakharpe, MD, MPH, Manthan Makadia, MD, Leopoldo M Baccaro, MD, Vinay Singhal, MD. Easton Hospital, Drexel University College of Medicine.

Introduction: Patients undergoing gastric bypass surgery have a high risk for thromboembolic events. Over the last decade the use of prophylactic IVC filter (IVCF) placement has drastically increased for patients who are considered high risk. However, the role and efficacy of prophylactic IVCF placement remains controversial and the literature is limited to a few retrospective studies.

Methods: We conducted a systematic review of the literature. Twenty-one articles were analyzed and a total of eight relevant retrospective studies were chosen for review of data. Data from laparoscopic gastric bypass surgery was compared to open gastric bypass surgery.

Results: The relevant eight retrospective studies included a total of 597 patients. Patients had IVCF placement before laparoscopic gastric bypass (41%) and before open gastric bypass (59%). There were 5 postoperative pulmonary emboli (PE) (0.84%), 21 DVTs (3.52%), 5 minor IVCF related complications (0.84%), 2 major IVCF related complications (0.34%) and 10 deaths (1.68%). The rate of postoperative PE was the same in the laparoscopic group and the open group (0.84%). The rate of DVT in the laparoscopic group was 5.02% and in the open group it was 2.23%.

Discussion: It is estimated that 55% of bariatric surgeons use IVCF in high risk patients. Prospective research that supports the use of IVCF is very limited and individualized placement relies on retrospective studies only. In addition, patient characteristics associated with high risk vary between different studies. Our review showed that most of the published studies support the use of prophylactic IVCF and found it to be safe. On the other hand, the largest and most recent retrospective cohort study does not support its use.

Conclusion: The efficacy of prophylactic IVCF before gastric bypass surgery in high risk patients has not been established. Despite recent data suggesting no benefit, previous studies have supported its use in high risk patients. However, the patient population that is considered to be at high risk is not clearly defined.


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