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2010 Annual Meeting Abstracts

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Indications For Prophylactic Preoperative Retrievable Inferior Vena Cava Filters In Bariatric Patients Should Be Reevaluated
*Robert A Brenes, *Laila Rashidi, *Hussain M.A. Abbas, Stanley J Dudrick, *J. Alexander Palesty
Saint Mary's Hospital, Waterbury, CT

Objective: To evaluate indications for prophylactic preoperative retrievable inferior vena cava (IVC) filters, and to assess their validity as predisposing factors for pulmonary embolism (PE) in bariatric patients
Design: Retrospective chart review over 7 years (2003-2009)
Setting: University affiliated, community teaching hospital
Patients: All patients who underwent gastric bypass procedures (n=293)
Interventions: None
Main Outcome Measures: Development of PE or evidence of clot formation present on fluoroscopic evaluation prior to removal of IVC filter
Results: Patients were divided into those with preoperative placement of an IVC filter (n=56), and those without an IVC filter (n=237). Clot was captured in 8 (14%) of 56 filters. A previous DVT was the only statistically significant predictor for clot capture (p < 0.05). Operative time, BMI, age, and history of smoking were not statistically significant in predicting clot formation. Older patients and those with a higher BMI (average 55.9) were more likely to have a filter placed (p < 0.05). One patient in the non-filter group had a PE, and two in the filter group developed a PE. Retrievable filters were unable to be removed in 5% of patients.
Conclusions: Preoperative IVC filters in bariatric patients have been advocated during the past several years. A significant portion of them are unable to be retrieved, and the long term sequela are unknown. IVC filter placement should be individualized and based on high risk for PE in patients with predisposing factors of clot formation, and not based on BMI alone.

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