Safety, feasibility, and outcome of retrievable vena cava filters in high-risk surgical patients

Abstract

Objective: Retrievable vena cava filters (rVCFs) are being used frequently in the perioperative setting for preventing pulmonary embolism. The indications and safety profile for placement of preoperative retrievable vena cava filters (rVCFs) remains undefined, however. This study sought to determine the safety, feasibility, and outcome of rVCFs in bariatric surgery patients, who are known as a high-risk population for periprocedural deep vein thrombus (DVT) or pulmonary embolus, or both.

Methods: Between June 1, 2004, and October 1, 2005, protocols were developed and implemented at a tertiary referral hospital for placement of rVCFs in 59 consecutive high-risk patients undergoing laparoscopic gastric bypass or duodenal switch if they met any of the following criteria: body mass index >55 kg/m(2), hypercoagulable state, severe immobility, venous stasis, or previous history of DVT or pulmonary embolus. Using both Site-Rite (Bard Access Systems, Salt Lake City, Utah) ultrasound and fluoroscopy, Günther Tulip (Cook, Inc., Bloomington, Ind) rVCFs were placed immediately after general anesthesia, just preceding the bariatric procedure. The internal jugular vein was the preferred approach, followed by the femoral vein. Retrieval was performed after the fourth postoperative week.

Results: During a 16-month period, 60 rVCFs were placed in 61 attempts, 57 through the internal jugular vein and three through the femoral vein. Six patients refused the retrieval attempt. Of the remaining 54 rVCFs, the primary retrieval success was 90% (49/54), with all failures due to severe filter tilt. The secondary retrieval success was 100% (3/3). The two remaining patients refused secondary retrieval attempt. The mean +/- standard deviation dwell time of the rVCFs was 63 +/- 30 days. No procedure complications occurred in placement or retrieval. One patient developed a clinical pulmonary embolism with the filter in place while not receiving postoperative anticoagulation. No patients died. The mean body mass index of the patients was 61 +/- 10 kg/m(2).

Conclusion: Placement and retrieval of retrievable vena cava filters in high-risk bariatric surgery patients is safe, feasible, and offers potential clinical benefit to patients requiring short-term protection from pulmonary embolism.