Prophylactic Vena Cava Filters in High Risk Patients Undergoing Bariatric Surgery

Objectives: Bariatric Surgery (BS) is now recognized as an avenue for the morbidly obese to lose weight. A leading cause of mortality and morbidity in BS is pulmonary embolus (PE) and deep vein thrombosis (DVT). The use of vena cava filters (VCF) have been recognized as an effective means of preventing PE. If VCF can be placed with low risk of morbidity, it should be considered as a means to prevent PE in high risk patients. The objective of this study was to clarify if those patients who are high risk for DVT/PE and are undergoing Roux en Y gastric bypass (RYGB) for morbid obesity benefit from prophylactic VCF.
Methods: 330 VCF were placed during a 5 year period for standard therapeutic indications. An additional 106 VCF's were placed prophylacticly ( via femoral access) in high risk patients undergoing RYGB . High risk patients were those with a previos history of DVT/PE or combination of venous stasis, Sleep apnea and BMI over 60%. The number of patients having RYGB during this interval was 1878. Patients were evaluated for migration, caval thrombosis, PE, hematoma or secondary DVT
Results: Of the 330 patients having therapeutic filters, .1 thrombosis ,.1 had groin hematoma and no migrations or secondary DVT. In the BS group, there was 1 caval thrombosis and 1 mortality form PE .
Conclusion: With the low rate of complication in patients having VCF, high risk patients undergoing BS should be considered for prophylactic VCF placements.