Long-term outcome of inferior vena cava filter placement in patients undergoing gastric bypass

Nicholas J. Gargiulo, David J. O'Connor, Frank J. Veith, Evan C. Lipsitz, Pratt Vemulapalli, Karen Gibbs, William D. Suggs

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: It has been well established that inferior vena cava (IVC) filter placement at the time of open gastric bypass (OGB) surgery in patients with a body mass index of more than 55 kg/m2 reduces both the pulmonary embolism rate and the perioperative mortality. However, little is known about the long-term effects of IVC filter placement in this particular group of patients. Methods: Over an 8-year period, a total of 571 morbid obese patients underwent OGB procedures, and 58 (10%) of them required placement of an IVC filter before their procedure. All IVC filters were placed percutaneously through a femoral vein approach using a portable OEC fluoroscope. Types of IVC filters used in our study included the TrapEase (n = 35), Simon-Nitinol (n = 9), Greenfield (n = 2), and Bard Recovery (n = 12). Results: Of the 58 patients who required an IVC placement, 56 remained free of any thromboembolic phenomena over the 8-year period (range, 1-8 years). The remaining two patients developed deep venous thrombosis. One patient was successfully treated with intravenous heparin and a 6-month course of Coumadin. She had complete resolution of her deep venous thrombosis and was incidentally noted to have a prothrombin 20210 gene mutation. The other patient, who had multiple gastric bypass complications, could not be successfully treated with intravenous heparin and thus progressed on to complete IVC thrombosis. She developed phlegmasia cerulea dolens and required bilateral above-the-knee amputations. She subsequently died 3 months after her procedures. Conclusion: It appears that IVC filter placement at the time of OGB surgery is a relatively benign intervention with a maximal benefit. A note of caution should be exerted for those obese patients who have a hypercoagulable disorder and for those who have complications related to the gastric bypass. An aggressive posture, which may consist of immediate anticoagulation after their procedures (only when it is deemed safe), should be advocated in this small sub-group of morbid obese patients.

Original languageEnglish (US)
Pages (from-to)946-949
Number of pages4
JournalAnnals of Vascular Surgery
Volume24
Issue number7
DOIs
StatePublished - Oct 2010

Fingerprint

Vena Cava Filters
Gastric Bypass
Inferior Vena Cava
Venous Thrombosis
Heparin
Femoral Vein
Prothrombin
Warfarin
Posture
Pulmonary Embolism
Amputation
Knee
Body Mass Index
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gargiulo, N. J., O'Connor, D. J., Veith, F. J., Lipsitz, E. C., Vemulapalli, P., Gibbs, K., & Suggs, W. D. (2010). Long-term outcome of inferior vena cava filter placement in patients undergoing gastric bypass. Annals of Vascular Surgery, 24(7), 946-949. https://doi.org/10.1016/j.avsg.2010.05.004

Long-term outcome of inferior vena cava filter placement in patients undergoing gastric bypass. / Gargiulo, Nicholas J.; O'Connor, David J.; Veith, Frank J.; Lipsitz, Evan C.; Vemulapalli, Pratt; Gibbs, Karen; Suggs, William D.

In: Annals of Vascular Surgery, Vol. 24, No. 7, 10.2010, p. 946-949.

Research output: Contribution to journalArticle

Gargiulo, NJ, O'Connor, DJ, Veith, FJ, Lipsitz, EC, Vemulapalli, P, Gibbs, K & Suggs, WD 2010, 'Long-term outcome of inferior vena cava filter placement in patients undergoing gastric bypass', Annals of Vascular Surgery, vol. 24, no. 7, pp. 946-949. https://doi.org/10.1016/j.avsg.2010.05.004
Gargiulo, Nicholas J. ; O'Connor, David J. ; Veith, Frank J. ; Lipsitz, Evan C. ; Vemulapalli, Pratt ; Gibbs, Karen ; Suggs, William D. / Long-term outcome of inferior vena cava filter placement in patients undergoing gastric bypass. In: Annals of Vascular Surgery. 2010 ; Vol. 24, No. 7. pp. 946-949.
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abstract = "Background: It has been well established that inferior vena cava (IVC) filter placement at the time of open gastric bypass (OGB) surgery in patients with a body mass index of more than 55 kg/m2 reduces both the pulmonary embolism rate and the perioperative mortality. However, little is known about the long-term effects of IVC filter placement in this particular group of patients. Methods: Over an 8-year period, a total of 571 morbid obese patients underwent OGB procedures, and 58 (10{\%}) of them required placement of an IVC filter before their procedure. All IVC filters were placed percutaneously through a femoral vein approach using a portable OEC fluoroscope. Types of IVC filters used in our study included the TrapEase (n = 35), Simon-Nitinol (n = 9), Greenfield (n = 2), and Bard Recovery (n = 12). Results: Of the 58 patients who required an IVC placement, 56 remained free of any thromboembolic phenomena over the 8-year period (range, 1-8 years). The remaining two patients developed deep venous thrombosis. One patient was successfully treated with intravenous heparin and a 6-month course of Coumadin. She had complete resolution of her deep venous thrombosis and was incidentally noted to have a prothrombin 20210 gene mutation. The other patient, who had multiple gastric bypass complications, could not be successfully treated with intravenous heparin and thus progressed on to complete IVC thrombosis. She developed phlegmasia cerulea dolens and required bilateral above-the-knee amputations. She subsequently died 3 months after her procedures. Conclusion: It appears that IVC filter placement at the time of OGB surgery is a relatively benign intervention with a maximal benefit. A note of caution should be exerted for those obese patients who have a hypercoagulable disorder and for those who have complications related to the gastric bypass. An aggressive posture, which may consist of immediate anticoagulation after their procedures (only when it is deemed safe), should be advocated in this small sub-group of morbid obese patients.",
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