Safety of Retrievable Inferior Vena Cava Filter Placements in High-Risk Bariatric Surgery Patients

Address correspondence to: Marcoandrea Giorgi, MD, Department of Surgery, Brown University, Rhode Island Hospital, Providence, Rhode Island 02912, E-mail: [email protected]

Introduction

Bariatric surgery has proven to be the most effective treatment for sustained weight loss, leading to improved health for obese patients. Recent work confirms that glycemic control for diabetic patients is maintained long term in higher percentages than when compared with medical therapy alone.¹ Access to surgical therapy can be limited when patients present with increased operative risk, particularly with regard to venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE).

There is strong evidence in the literature that obesity is associated with increased risk of VTE.² Obesity interferes with both coagulation pathways, as well as with the anticoagulant mechanism, leading to a hypercoagulable state.² Perioperative factors such as surgical trauma, operative duration, anesthesia, and pneumoperitoneum likely increase this risk.^3,4

VTE is associated with high morbidity and mortality and is cause of more than 2,50,000 hospital admissions annually in the United States,² making it a feared postoperative complication. The incidence in average risk bariatric surgery patients is 1.3% for DVT and 1.1% for PE.^3-5 In patients defined at high risk, the incidence increases to 5.4% for DVT and 6.4% for PE.^6-9 Factors that increase risk include body mass index (BMI) >50, truncal obesity, advanced age, personal or family history of VTE, known hypercoagulable state, immobilization, venous insufficiency/stasis, smoking, use of estrogen containing oral contraceptives and hormone replacement therapy, and the comorbidity of obesity-hypoventilation syndrome.^10,11,12

In our study, we...