Sheu Alexander Y, Hoang Nam Sao, Kesselman Andrew J, Liang Tie, Rosenberg Jarrett K, Kuo William T
Division of Vascular and Interventional Radiology, Stanford University Medical Center, 300 Pasteur Drive, H-3651, Stanford, CA 94305-5642 USA.
CVIR Endovasc. 2018;1(1):13. doi: 10.1186/s42155-018-0021-5. Epub 2018 Nov 15.
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.
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.
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.
NCT01158482.
减肥手术患者发生静脉血栓栓塞（VTE）的风险增加，但下腔静脉滤器在该群体中的潜在风险与益处仍不明确。留置滤器可能会增加VTE风险，且肥胖患者取出滤器具有挑战性。本研究评估了接受预防性下腔静脉滤器的特定减肥手术患者中VTE的发生率、滤器相关并发症的风险以及尝试取出滤器的结果。
术后3个月内，3例患者（3%）（95%置信区间：1%-9%）发生术后深静脉血栓形成（DVT），1例患者（1%）（95%置信区间：0%-5%）在术后31天，即滤器取出前发生急性低风险肺栓塞（PE）。除1例需要溶栓治疗外，所有VTE患者仅通过治疗性抗凝就成功得到处理。滤器中位留置时间为54天（范围：22 - 1548天），且未发生与滤器相关的严重并发症（0%）（95%置信区间：0%-3%）。104例（97%）（95%置信区间：92%-99%）尝试取出滤器，其中104例（100%）（95%置信区间：97%-100%）成功取出。33例患者（32%）（95%置信区间：23%-42%）需要采用先进技术取出滤器，且未发生严重手术并发症（0%）（95%置信区间：0%-3%）。滤器取出后中位随访时间为344天（范围：3 - 1570天）。
在接受预防性下腔静脉滤器联合机械和化学预防措施的这组高危减肥手术患者中，未发生危及生命的术后PE病例。滤器相关并发症风险较低，辅助使用先进技术时取出成功率较高。
NCT01158482
