Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures
Patients undergoing open gastric bypass (OGB) for morbid obesity are at significant risk for pulmonary embolism (PE) despite the use of subcutaneous heparin injections and sequential compression devices. Prophylactic preoperative inferior vena cava (IVC) filter placement may reduce this risk. We rep...
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| Veröffentlicht in: | Journal of vascular surgery 2006-12, Vol.44 (6), p.1301-1305 |
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| creator | Gargiulo, Nicholas J. Veith, Frank J. Lipsitz, Evan C. Suggs, William D. Ohki, Takao Goodman, Elliot |
| description | Patients undergoing open gastric bypass (OGB) for morbid obesity are at significant risk for pulmonary embolism (PE) despite the use of subcutaneous heparin injections and sequential compression devices. Prophylactic preoperative inferior vena cava (IVC) filter placement may reduce this risk. We report our experience with simultaneous IVC filter placement and OGB in an operating room setting.
From July 1999 to April 2001, 193 patients (group 1) underwent OGB. Eight patients had prophylactic intraoperative IVC filters placed for deep vein thrombosis, PE, or pulmonary hypertension. From May 2001 to January 2003, 181 patients (group 2) underwent OGB. There were 33 IVC filters placed for body mass index (BMI) greater than 55 kg/m2 in addition to the above-mentioned criteria. To confirm observations made in group 1 and 2 patients, from July 2003 to May 2005, 197 patients (group 3) underwent OGB, and patients with a BMI greater than 55 kg/m2 (n = 35) were offered IVC filter placement. Group 3A (n = 17) consented to IVC filter placement, and group 3B (n = 18) did not.
Fifty-eight IVC filters were placed (100% technical success rate) with an increase in operating room time of 20 ± 5 minutes. In group 1, the eight patients with IVC filters had a BMI greater than 55 kg/m2. There were four PEs (3 fatal and 1 nonfatal) in the other 185 patients, all which occurred in patients with BMIs greater than 55 kg/m2. In group 2, there were no PEs. The perioperative PE rate in these patients was reduced from 13% (4/31; 95% confidence interval [CI], 1.1%-25.7%) to 0% (0/33; 95% CI, 0%-8.7%). Perioperative mortality was reduced from 10% (3/31; 95% CI, 0%-20.0%) to 0% (0/33; 95% CI, 0%-8.7%). There were no pulmonary emboli or deaths related to PE in group 3A patients. Group 3B patients had a 28% PE rate (two fatal and three nonfatal) and an 11% PE-related death rate. None of the remaining patients in group 3 had a PE.
Intraoperative IVC filter placement for the prevention of PE in morbidly obese patients undergoing OGB is feasible. We observed a significant reduction in the perioperative PE rate when a BMI greater than 55 kg/m2 was used as an indication for IVC filter placement despite the use of subcutaneous heparin injections and sequential compression devices. |
| doi_str_mv | 10.1016/j.jvs.2006.08.021 |
| format | Article |
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From July 1999 to April 2001, 193 patients (group 1) underwent OGB. Eight patients had prophylactic intraoperative IVC filters placed for deep vein thrombosis, PE, or pulmonary hypertension. From May 2001 to January 2003, 181 patients (group 2) underwent OGB. There were 33 IVC filters placed for body mass index (BMI) greater than 55 kg/m2 in addition to the above-mentioned criteria. To confirm observations made in group 1 and 2 patients, from July 2003 to May 2005, 197 patients (group 3) underwent OGB, and patients with a BMI greater than 55 kg/m2 (n = 35) were offered IVC filter placement. Group 3A (n = 17) consented to IVC filter placement, and group 3B (n = 18) did not.
Fifty-eight IVC filters were placed (100% technical success rate) with an increase in operating room time of 20 ± 5 minutes. In group 1, the eight patients with IVC filters had a BMI greater than 55 kg/m2. There were four PEs (3 fatal and 1 nonfatal) in the other 185 patients, all which occurred in patients with BMIs greater than 55 kg/m2. In group 2, there were no PEs. The perioperative PE rate in these patients was reduced from 13% (4/31; 95% confidence interval [CI], 1.1%-25.7%) to 0% (0/33; 95% CI, 0%-8.7%). Perioperative mortality was reduced from 10% (3/31; 95% CI, 0%-20.0%) to 0% (0/33; 95% CI, 0%-8.7%). There were no pulmonary emboli or deaths related to PE in group 3A patients. Group 3B patients had a 28% PE rate (two fatal and three nonfatal) and an 11% PE-related death rate. None of the remaining patients in group 3 had a PE.
Intraoperative IVC filter placement for the prevention of PE in morbidly obese patients undergoing OGB is feasible. We observed a significant reduction in the perioperative PE rate when a BMI greater than 55 kg/m2 was used as an indication for IVC filter placement despite the use of subcutaneous heparin injections and sequential compression devices.</description><identifier>ISSN: 0741-5214</identifier><identifier>EISSN: 1097-6809</identifier><identifier>DOI: 10.1016/j.jvs.2006.08.021</identifier><identifier>PMID: 17055691</identifier><identifier>CODEN: JVSUES</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Body Mass Index ; Diseases of the cardiovascular system ; Female ; Follow-Up Studies ; Gastric Bypass - adverse effects ; Humans ; Male ; Medical sciences ; Obesity, Morbid - mortality ; Obesity, Morbid - surgery ; Primary Prevention - methods ; Prospective Studies ; Pulmonary Embolism - etiology ; Pulmonary Embolism - prevention & control ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Retrospective Studies ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival Analysis ; Time Factors ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels ; Vena Cava Filters</subject><ispartof>Journal of vascular surgery, 2006-12, Vol.44 (6), p.1301-1305</ispartof><rights>2006 The Society for Vascular Surgery</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-bdc9a038e136b5c349dbdd7c17cfb05b14f66f8f3644a7c99ef051a8feff41a43</citedby><cites>FETCH-LOGICAL-c424t-bdc9a038e136b5c349dbdd7c17cfb05b14f66f8f3644a7c99ef051a8feff41a43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0741521406014856$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=18355715$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17055691$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gargiulo, Nicholas J.</creatorcontrib><creatorcontrib>Veith, Frank J.</creatorcontrib><creatorcontrib>Lipsitz, Evan C.</creatorcontrib><creatorcontrib>Suggs, William D.</creatorcontrib><creatorcontrib>Ohki, Takao</creatorcontrib><creatorcontrib>Goodman, Elliot</creatorcontrib><title>Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures</title><title>Journal of vascular surgery</title><addtitle>J Vasc Surg</addtitle><description>Patients undergoing open gastric bypass (OGB) for morbid obesity are at significant risk for pulmonary embolism (PE) despite the use of subcutaneous heparin injections and sequential compression devices. Prophylactic preoperative inferior vena cava (IVC) filter placement may reduce this risk. We report our experience with simultaneous IVC filter placement and OGB in an operating room setting.
From July 1999 to April 2001, 193 patients (group 1) underwent OGB. Eight patients had prophylactic intraoperative IVC filters placed for deep vein thrombosis, PE, or pulmonary hypertension. From May 2001 to January 2003, 181 patients (group 2) underwent OGB. There were 33 IVC filters placed for body mass index (BMI) greater than 55 kg/m2 in addition to the above-mentioned criteria. To confirm observations made in group 1 and 2 patients, from July 2003 to May 2005, 197 patients (group 3) underwent OGB, and patients with a BMI greater than 55 kg/m2 (n = 35) were offered IVC filter placement. Group 3A (n = 17) consented to IVC filter placement, and group 3B (n = 18) did not.
Fifty-eight IVC filters were placed (100% technical success rate) with an increase in operating room time of 20 ± 5 minutes. In group 1, the eight patients with IVC filters had a BMI greater than 55 kg/m2. There were four PEs (3 fatal and 1 nonfatal) in the other 185 patients, all which occurred in patients with BMIs greater than 55 kg/m2. In group 2, there were no PEs. The perioperative PE rate in these patients was reduced from 13% (4/31; 95% confidence interval [CI], 1.1%-25.7%) to 0% (0/33; 95% CI, 0%-8.7%). Perioperative mortality was reduced from 10% (3/31; 95% CI, 0%-20.0%) to 0% (0/33; 95% CI, 0%-8.7%). There were no pulmonary emboli or deaths related to PE in group 3A patients. Group 3B patients had a 28% PE rate (two fatal and three nonfatal) and an 11% PE-related death rate. None of the remaining patients in group 3 had a PE.
Intraoperative IVC filter placement for the prevention of PE in morbidly obese patients undergoing OGB is feasible. We observed a significant reduction in the perioperative PE rate when a BMI greater than 55 kg/m2 was used as an indication for IVC filter placement despite the use of subcutaneous heparin injections and sequential compression devices.</description><subject>Biological and medical sciences</subject><subject>Body Mass Index</subject><subject>Diseases of the cardiovascular system</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastric Bypass - adverse effects</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Obesity, Morbid - mortality</subject><subject>Obesity, Morbid - surgery</subject><subject>Primary Prevention - methods</subject><subject>Prospective Studies</subject><subject>Pulmonary Embolism - etiology</subject><subject>Pulmonary Embolism - prevention & control</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Retrospective Studies</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><subject>Vena Cava Filters</subject><issn>0741-5214</issn><issn>1097-6809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi0EotvCA3BBvtBbgiexHUecUNUCUiUu7dly7PHiVdYJdrKlb4-XXak3TqORvn9m9A0hH4DVwEB-3tW7Q64bxmTNVM0aeEU2wPqukor1r8mGdRwq0QC_IJc57xgDEKp7Sy6gY0LIHjYk3P6ZMQWMFulTWH7REH3pp0QPGA215mCoD-OCic6jsbjHuBSGzmYpoSXTNTpM2ynELZ1mjHRr8pKCpcPzbHKmc5osujVhfkfeeDNmfH-uV-Tx7vbh5nt1__Pbj5uv95XlDV-qwdnesFYhtHIQtuW9G5zrLHTWD0wMwL2UXvlWcm462_fomQCjPHrPwfD2ilyf5pbVv1fMi96HbHEcTcRpzVqqBnqQooBwAm2ack7o9ZzC3qRnDUwf_eqdLn710a9mShe_JfPxPHwd9uheEmehBfh0Bky2ZvTJRBvyC6daITo4Lv9y4rCoOARMOtt_X3AhoV20m8J_zvgLteSbNA</recordid><startdate>20061201</startdate><enddate>20061201</enddate><creator>Gargiulo, Nicholas J.</creator><creator>Veith, Frank J.</creator><creator>Lipsitz, Evan C.</creator><creator>Suggs, William D.</creator><creator>Ohki, Takao</creator><creator>Goodman, Elliot</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20061201</creationdate><title>Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures</title><author>Gargiulo, Nicholas J. ; Veith, Frank J. ; Lipsitz, Evan C. ; Suggs, William D. ; Ohki, Takao ; Goodman, Elliot</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-bdc9a038e136b5c349dbdd7c17cfb05b14f66f8f3644a7c99ef051a8feff41a43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Biological and medical sciences</topic><topic>Body Mass Index</topic><topic>Diseases of the cardiovascular system</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastric Bypass - adverse effects</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Obesity, Morbid - mortality</topic><topic>Obesity, Morbid - surgery</topic><topic>Primary Prevention - methods</topic><topic>Prospective Studies</topic><topic>Pulmonary Embolism - etiology</topic><topic>Pulmonary Embolism - prevention & control</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Retrospective Studies</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><topic>Vena Cava Filters</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gargiulo, Nicholas J.</creatorcontrib><creatorcontrib>Veith, Frank J.</creatorcontrib><creatorcontrib>Lipsitz, Evan C.</creatorcontrib><creatorcontrib>Suggs, William D.</creatorcontrib><creatorcontrib>Ohki, Takao</creatorcontrib><creatorcontrib>Goodman, Elliot</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of vascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gargiulo, Nicholas J.</au><au>Veith, Frank J.</au><au>Lipsitz, Evan C.</au><au>Suggs, William D.</au><au>Ohki, Takao</au><au>Goodman, Elliot</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures</atitle><jtitle>Journal of vascular surgery</jtitle><addtitle>J Vasc Surg</addtitle><date>2006-12-01</date><risdate>2006</risdate><volume>44</volume><issue>6</issue><spage>1301</spage><epage>1305</epage><pages>1301-1305</pages><issn>0741-5214</issn><eissn>1097-6809</eissn><coden>JVSUES</coden><abstract>Patients undergoing open gastric bypass (OGB) for morbid obesity are at significant risk for pulmonary embolism (PE) despite the use of subcutaneous heparin injections and sequential compression devices. Prophylactic preoperative inferior vena cava (IVC) filter placement may reduce this risk. We report our experience with simultaneous IVC filter placement and OGB in an operating room setting.
From July 1999 to April 2001, 193 patients (group 1) underwent OGB. Eight patients had prophylactic intraoperative IVC filters placed for deep vein thrombosis, PE, or pulmonary hypertension. From May 2001 to January 2003, 181 patients (group 2) underwent OGB. There were 33 IVC filters placed for body mass index (BMI) greater than 55 kg/m2 in addition to the above-mentioned criteria. To confirm observations made in group 1 and 2 patients, from July 2003 to May 2005, 197 patients (group 3) underwent OGB, and patients with a BMI greater than 55 kg/m2 (n = 35) were offered IVC filter placement. Group 3A (n = 17) consented to IVC filter placement, and group 3B (n = 18) did not.
Fifty-eight IVC filters were placed (100% technical success rate) with an increase in operating room time of 20 ± 5 minutes. In group 1, the eight patients with IVC filters had a BMI greater than 55 kg/m2. There were four PEs (3 fatal and 1 nonfatal) in the other 185 patients, all which occurred in patients with BMIs greater than 55 kg/m2. In group 2, there were no PEs. The perioperative PE rate in these patients was reduced from 13% (4/31; 95% confidence interval [CI], 1.1%-25.7%) to 0% (0/33; 95% CI, 0%-8.7%). Perioperative mortality was reduced from 10% (3/31; 95% CI, 0%-20.0%) to 0% (0/33; 95% CI, 0%-8.7%). There were no pulmonary emboli or deaths related to PE in group 3A patients. Group 3B patients had a 28% PE rate (two fatal and three nonfatal) and an 11% PE-related death rate. None of the remaining patients in group 3 had a PE.
Intraoperative IVC filter placement for the prevention of PE in morbidly obese patients undergoing OGB is feasible. We observed a significant reduction in the perioperative PE rate when a BMI greater than 55 kg/m2 was used as an indication for IVC filter placement despite the use of subcutaneous heparin injections and sequential compression devices.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17055691</pmid><doi>10.1016/j.jvs.2006.08.021</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Body Mass Index Diseases of the cardiovascular system Female Follow-Up Studies Gastric Bypass - adverse effects Humans Male Medical sciences Obesity, Morbid - mortality Obesity, Morbid - surgery Primary Prevention - methods Prospective Studies Pulmonary Embolism - etiology Pulmonary Embolism - prevention & control Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Retrospective Studies Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis Time Factors Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels Vena Cava Filters |
| title | Experience with inferior vena cava filter placement in patients undergoing open gastric bypass procedures |
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