Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC, 20037, USA.
Obes Surg. 2011 Oct;21(10):1580-4. doi: 10.1007/s11695-010-0301-1.
Bariatric patients are at significant risk for venous thromboembolism (VTE) and a subset may benefit from retrievable inferior vena cava filters (rIVCFs). Optimal VTE prophylaxis and a consensus on factors which make bariatric patients high risk have not been established. This study describes our experience with the use of rIVCFs in combination with chemoprophylaxis for high-risk bariatric surgery patients.
A retrospective review was performed of high-risk patients bariatric surgery patients. Patients with a hypercoaguable condition, prior history of VTE, body mass index (BMI) > 55 kg/m(2), and severe immobility were considered high risk. Patients underwent rIVCF placement and standard chemoprophylaxis. A venogram was performed at retrieval.
Forty-four patients, age of 48 ± 12 years and BMI of 58.4 ± 9.4 kg/m(2) underwent gastric bypass with rIVCF placement. Follow-up was 204 days. One patient had a preoperative deep venous thrombosis (DVT). All patients received chemoprophylaxis and rIVCF placement. Indications for rIVCF were BMI (68%), prior VTE (30%), and immobility (2%). The operation was performed laparoscopically in all patients, and the mean operative time was 106.1 ± 21.6 min and length of stay was 3.1 ± 1.2 days. Postoperative venous duplex revealed two DVTs (5%). Retrieval was successful in 28 patients. No significant thrombus was found on venogram. Two minor complications of filter placement occurred. One mortality occurred due to MI, and no pulmonary emboli were clinically evident.
rIVCFs in our cohort of high-risk bariatric surgery patients was associated with an acceptably low incidence of DVT (5%) and no clinically evident PE. Despite safe removal after long dwell times, previous data suggest that rIVCFs are associated with a higher incidence of VTE. Thus, filters, if placed, should be removed once the risk of VTE has passed. Larger multicenter studies are needed to truly identify long-term safety and efficacy of rIVCFs.
肥胖症患者存在发生静脉血栓栓塞症（venous thromboembolism，VTE）的重大风险，部分患者可能受益于可回收下腔静脉滤器（retrievable inferior vena cava filters，rIVCFs）。目前尚未确定 VTE 的最佳预防措施以及使肥胖症患者成为高危人群的相关因素。本研究描述了我们在高危肥胖症手术患者中联合使用 rIVCFs 和化学预防的经验。
对高危肥胖症手术患者进行回顾性研究。有高凝状态、VTE 病史、体重指数（body mass index，BMI）>55kg/m2 和严重活动受限的患者被认为是高危患者。患者接受 rIVCF 植入和标准化学预防。在回收时进行静脉造影。
44 例患者，年龄 48±12 岁，BMI 为 58.4±9.4kg/m2，行胃旁路术并植入 rIVCF。随访时间为 204 天。1 例患者术前有深静脉血栓形成（DVT）。所有患者均接受化学预防和 rIVCF 植入。rIVCF 的适应证为 BMI（68%）、既往 VTE（30%）和活动受限（2%）。所有患者均行腹腔镜手术，手术时间平均为 106.1±21.6 分钟，住院时间为 3.1±1.2 天。术后静脉双功超声检查发现 2 例 DVT（5%）。28 例患者成功回收 rIVCF。静脉造影未见明显血栓。发生 2 例轻微滤器放置并发症。1 例患者因心肌梗死死亡，无临床明显的肺栓塞。
在本高危肥胖症手术患者队列中，rIVCF 与可接受的低 DVT 发生率（5%）和无临床明显的 PE 相关。尽管在长时间留置后可安全取出，但先前的数据表明 rIVCF 与更高的 VTE 发生率相关。因此，如果放置了滤器，一旦 VTE 风险过去，就应将其取出。需要更大规模的多中心研究来真正确定 rIVCF 的长期安全性和有效性。
