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Safety of Retrievable Inferior Vena Cava Filter Placements in High Risk Bariatric Surgery Patients
*Marcoandrea Giorgi1, G. Dean Roye1, *Tec Chong2, *Junaid Malek3, *Joon K Shim1, *Suma Sangisetty4, Beth A Ryder1, *Todd Stafford1, Sivamainthan Vithiananthan1
1Brown University, Providence, RI;2Singapore National University, Singapore, Singapore3Massachussets General Hospital, Boston, MA;4Ochsner Health Center, Kenner, LA

Objective: To assess the safety of retrievable inferior vena cava filter placements (IVCf) in high risk bariatric surgery patients.
Design: Retrospective cohort.
Setting: Single center, inpatient and outpatient
Patients: Patients with BMI >50, history of thrombo-embolic events, hyper-coagulable conditions and low mobility predisposing factors were defined as high risk and included.
Interventions: 73% of patients received laparoscopic gastric bypass, 16.6% laparoscopic gastric banding, 10.4% laparoscopic sleeve gastrectomy. All patients received retrievable IVCf placement, preoperative heparin, postoperative enoxaparin for 4 weeks.
Main Outcome Measures: Success in filter removal, complications, failure to follow-up.
Results: 49 patients, 36 females and 13 males were reviewed. Mean age was 48, mean BMI was 53. 54.1% of the patients received preoperative IVCf for BMI >50 (26), 27.2% for personal history of DVT/PE (13), 6.2% for family history of DVT/PE (3), 8.3% for hyper-coagulable state without prior DVT/PE (4), 4.2% for low mobility (2). Mean duration of filter placement was 92 days. In this population 1 patient had a failed IVCf placement, 1 had a clnically insignificant pulmonary embolism. 27% of patients (13) had blood clot on IVCf pathology report at removal. 98% of filters (47/48) were successfully removed with no complications, 1 patient did not return for follow-up.
Conclusions: In our study, retrievable IVCf placement in bariatric surgery patients at highest risk for DVT/PE appears to be safe and protective against thrombotic events. Although the literature suggests most retrievable IVCf are often not explanted as planned, nearly all of our patients undwewent planned IVCf retrieval post-operatively. Our study suggests these patients can benefit from the protective effects of the filter while avoiding long-term complications by undergoing successful planned interval IVCf removal.


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