Trigilio-Black Christa M, Ringley Chad D, McBride Corrigan L, Sorensen Victor J, Thompson Jon S, Longo G Matthew, Pipinos Iraklis I, Johanning Jason M
Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-3280, USA.
Surg Obes Relat Dis. 2007 Jul-Aug;3(4):461-4. doi: 10.1016/j.soard.2007.03.243. Epub 2007 Jun 4.
Pulmonary embolism (PE) is a leading cause of mortality after bariatric surgery. We evaluated inferior vena cava (IVC) filter use for PE risk reduction in high-risk super morbidly obese bariatric surgery patients.
IVC filters were inserted according to the patient's risk factors, including immobility, previous deep venous thrombosis (DVT)/PE, venous stasis, and pulmonary compromise. All filters were placed concomitant to bariatric surgery and were placed through a right internal jugular vein access site. We analyzed the prospectively collected data from this cohort and evaluated the incidence of PE and complications.
Since April 2003, 41 patients (12 men and 29 women) with a mean age of 47.3 +/- 10.0 years and body mass index of 64.2 +/- 12 kg/m2 (range 47-105) underwent IVC filter placement. These and all other patients underwent standard DVT/PE risk reduction measures. All IVC filter patients had one or more significant risk factors for thromboembolic events. No instances of PE were documented, although 1 patient experienced DVT, and no immediate or late complications related to filter placement occurred. One patient, with a body mass index of 105 kg/m2, died secondary to rhabdomyolysis after an extended procedure. The average filter placement time was 34.3 +/- 9 minutes.
IVC filter placement for PE risk reduction is safe and feasible in the super morbidly obese. Our data have shown that the filters can be placed expeditiously and with minimal morbidity concomitant with bariatric surgery. In this limited series, IVC filter placement was associated with no PE. Additional studies are needed to confirm the efficacy of IVC filter placement for PE risk reduction and related mortality in the super morbidly obese.
肺栓塞（PE）是减肥手术后死亡的主要原因。我们评估了下腔静脉（IVC）滤器在高危超级病态肥胖减肥手术患者中用于降低PE风险的效果。
根据患者的风险因素插入IVC滤器，这些因素包括活动受限、既往深静脉血栓形成（DVT）/PE、静脉淤滞和肺功能损害。所有滤器均在减肥手术时同时放置，通过右颈内静脉穿刺置入。我们分析了该队列前瞻性收集的数据，并评估了PE和并发症的发生率。
自2003年4月以来，41例患者（12例男性和29例女性）接受了IVC滤器置入，平均年龄为47.3±10.0岁，体重指数为64.2±12kg/m²（范围47 - 105）。这些患者以及所有其他患者均接受了标准的DVT/PE风险降低措施。所有IVC滤器置入患者均有一个或多个血栓栓塞事件的显著风险因素。尽管有1例患者发生DVT，但未记录到PE病例，且未发生与滤器置入相关的即时或晚期并发症。1例体重指数为105kg/m²的患者在长时间手术后因横纹肌溶解继发死亡。滤器平均置入时间为34.3±9分钟。
在超级病态肥胖患者中，置入IVC滤器以降低PE风险是安全可行的。我们的数据表明，滤器可以在减肥手术时快速置入，且发病率极低。在这个有限的系列研究中，IVC滤器置入与未发生PE相关。需要进一步研究来证实IVC滤器置入在超级病态肥胖患者中降低PE风险及相关死亡率的疗效。
