Abstract No. 203 - Prophylactic IVC filter placement in bariatric surgery patients: initial results from a prospective filter registry

Abstract

Bariatric surgery patients are at moderate to high risk for VTE (1), but potential risks versus benefits of IVC filters in this group remain unclear (2). Indwelling filters may increase risk of VTE (3), and removal of filters in obese patients can be challenging (3). This study evaluated the incidence of VTE in bariatric patients receiving prophylactic IVC filters, their risk of filter-related complications, and outcomes from attempted filter retrieval. Over 4 years, 100 patients receiving an IVC filter prior to bariatric surgery were prospectively enrolled in a single-center IRB-approved study. Filters were placed if patients had BMI>50 kg/m2 and/or VTE risk factors per ASMBS guidelines (1), and all received mechanical (SCDs) and chemo-prophylaxis (UFH/LMWH). There were 29 men, 71 women, mean age = 49.0 ± 10.7 y; mean BMI = 58.0 ± 9.3. Retrievable filters were used (89 Gunther Tulip, 4 Option, 4 Denali, 2 ALN, 1 Celect) and patients underwent Roux-en-Y gastric bypass (n = 87) or sleeve gastrectomy (n = 13). All were contacted for follow-up and filter retrieval was attempted when no longer needed. All data were captured using REDCap. Postsurgical DVT occurred in 4(4%) (95%CI:1.0-10.0), at median 50 d (range: 17-94), and 1 patient (1%) (95%CI:0.03-5.0) developed acute low-risk PE at 23 days post-op, prior to filter removal. All VTE patients were successfully managed with therapeutic anticoagulation alone except one who also required thrombolysis to resolve IVC and iliofemoral DVT. Average filter dwell time was 146 d (range: 26-1548) and there were no major filter-related complications (0%). Retrieval was attempted in 96/100(96%) and successful in 96/96(100%). 28/96(29%) required advanced techniques for filter removal, and there were no major procedural complications (0%). Mean follow-up was 459.8 ± 407.7 days and 2 developed acute DVT > 1 year after filter retrieval, successfully treated with anticoagulation. Prophylactic IVC filters in combination with mechanical and chemoprophylaxis may help prevent life-threatening post-op PE in select bariatric surgery patients. The risk of filter-related complications was low, and retrieval success was high with adjunctive use of advanced techniques.