Prophylactic IVC filter placement in bariatric surgery patients: results from a prospective filter registry

Alexander Y Sheu, Nam Sao Hoang, Andrew J Kesselman, Tie Liang, Jarrett K Rosenberg, William T Kuo, Alexander Y Sheu, Nam Sao Hoang, Andrew J Kesselman, Tie Liang, Jarrett K Rosenberg, William T Kuo

Abstract

Background: Bariatric surgery patients are at increased risk for VTE, but potential risks versus benefits of IVC filters in this group remain unclear. Indwelling filters may increase risk of VTE, and removal of filters in obese patients can be challenging. This study evaluated the incidence of VTE in select bariatric patients receiving prophylactic IVC filters, their risk of filter-related complications, and outcomes from attempted filter retrieval.

Results: Postsurgical DVT occurred in 3 patients within 3 months postoperatively (3%)(95%CI:1-9%), and 1 patient(1%)(95%CI:0-5%) developed acute low-risk PE at 31 days postoperatively, prior to filter removal. All VTE patients were successfully managed with therapeutic anticoagulation alone except one who required thrombolysis. Median filter dwell time was 54 days (range:22-1548), and there were no major filter-related complications (0%)(95%CI:0-3%). Retrieval was attempted in 104 cases (97%)(95%CI:92-99%) and successful in 104 cases (100%)(95%CI:97-100%). Thirty-three patients (32%)(95%CI:23-42%) required advanced techniques for filter removal, and there were no major procedural complications (0%)(95%CI:0-3%). Median follow-up occurred at 344 days (range:3-1570) days after filter retrieval.

Conclusions: No cases of life-threatening post-op PE occurred in this cohort of high-risk bariatric surgery patients receiving prophylactic IVC filters in combination with mechanical and chemoprophylaxis. The risk of filter-related complications was low and retrieval success was high with adjunctive use of advanced techniques.

Clinical trial registration: NCT01158482.

Keywords: Acute PE; Bariatric surgery; Inferior vena cava filter.

Conflict of interest statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Histogram of IVC filter dwell times. Most filters were retrieved within 90 days. Some filters were retrieved after 1 year, most frequently due to delayed bariatric surgery or noncompliance with initial follow-up requests
Fig. 2
Fig. 2
VTE episodes in 5 patients after bariatric surgery. Squares indicate occurrence of DVT; triangles indicate occurrence of PE; circles indicate IVC filter retrieval. VTE events occurring > 3 months postoperatively in cases #3 and #4 were deemed unrelated to bariatric surgery

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