Long-term Outcome of IVC Filter Placement in Patients Undergoing Gastric Bypass

Objectives: It has been previously established that inferior vena cava (IVC) filter placement at the time of open gastric bypass in patients with a body mass index (BMI) > 55 kg/m² reduces both the pulmonary embolism rate and perioperative mortality. Little is known regarding the long-term sequelae of IVC filter placement in this group of patients.
Methods: Over an 8 year period, 571 patients have undergone open gastric bypass procedures, and 58 of them required placement of an IVC filter prior to their procedure. All procedures were performed in the operating room prior to the gastric bypass procedure. A portable OEC fluoroscope and percutaneous femoral access was used. A variety of permanent and retrievable IVC filters were used including Trapease (n=35), Simon-Nitinol (n=9), Greenfield (n=2), and Bard Recovery (n=12).
Results: Fifty-six of the 58 patients remained free of thrombo-embolic phenomena over the 8 year period (range 1 year- 8 years). Two of the remaining patients developed femoral vein thrombosis (DVT). One was successfully treated with intravenous heparin and a six month course of coumadin. She had complete resolution of her DVT and was incidentally noted to have a prothrombin 20210 gene mutation. The other patient, who had multiple gastric bypass complications, was not successfully treated with intravenous heparin and progressed on to complete IVC thrombosis. She developed phlegmasia cerulea dolens and required bilateral above knee amputations. She subsequently died 3 months after her procedures.
Conclusions: It appears that IVC filter placement at the time of open gastric bypass is a relatively benign intervention with a maximal benefit. A note of caution should be exerted in those obese patients who have a hypercoagulable disorder and in those who have complications related to the gastric bypass. An aggressive posture should be advocated in this small sub-group of morbid obese patients which may consist of immediate anticoagulation (when it is deemed safe) following their procedures.