Safety of Retrievable Inferior Vena Cava Filter Placements in High-Risk Bariatric Surgery Patients

Background: Bariatric surgery patients are at a higher risk for venous thrombotic events. Inferior vena cava filter (IVCf) placement to prevent thrombotic complications is still considered controversial in bariatric surgery patients, especially when left in place long term. In this study, we describe our experience with the use of retrievable IVCf and their safety in bariatric surgery patients.Methods: A retrospective chart review was performed in a single bariatric surgery center. Patients with a body mass index (BMI) greater than 50, with a history of thromboembolic events, hypercoagulable conditions, and low mobility were defined as high risk and underwent exclusively retrievable IVCf placement. All also received preoperative heparin and postoperative low-molecular weight heparin prophylaxis. All patients underwent venogram during the filter retrieval.Results: Forty-nine patients, 36 females and 13 males, were reviewed. Mean age was 48, mean BMI was 53.7. Thirty-five patients underwent laparoscopic gastric bypass, 8 laparoscopic gastric banding, and 5 laparoscopic sleeve gastrectomy. 54.1% of patients received retrievable inferior vena cava filter (rIVCF) for a BMI >50 (n = 26); 27.2% for a personal history of deep venous thrombosis (DVT)/pulmonary embolism (PE) (n = 13); 6.2% for a family history of DVT/PE (n = 3); 8.3% for known hyper coagulable state without prior DVT/PE (n = 4); and 4.2% for low mobility or immobility (n = 2). Forty-eight patients out of 49 successfully received rIVCF. 98% of filters (47 out of 48) were removed successfully without any complications. One patient did not return to follow-up. One patient developed nonfatal DVT and PE, while the filter was still in place. There were no complications from filter placement or removal.Conclusions: The use of retrievable IVC filters for the prophylaxis of venous thromboembolism in bariatric surgery in conjunction with chemoprophylaxis therapy is safe and effective.