Prophylactic IVC filter placement in bariatric surgery patients: results from a prospective filter registry

BACKGROUND: Bariatric surgery patients are at increased risk for VTE, but potential risks versus benefits of IVC filters in this group remain unclear. Indwelling filters may increase risk of VTE, and removal of filters in obese patients can be challenging. This study evaluated the incidence of VTE in select bariatric patients receiving prophylactic IVC filters, their risk of filter-related complications, and outcomes from attempted filter retrieval. RESULTS: Postsurgical DVT occurred in 3 patients within 3 months postoperatively (3%)(95%CI:1–9%), and 1 patient(1%)(95%CI:0–5%) developed acute low-risk PE at 31 days postoperatively, prior to filter removal. All VTE patients were successfully managed with therapeutic anticoagulation alone except one who required thrombolysis. Median filter dwell time was 54 days (range:22–1548), and there were no major filter-related complications (0%)(95%CI:0–3%). Retrieval was attempted in 104 cases (97%)(95%CI:92–99%) and successful in 104 cases (100%)(95%CI:97–100%). Thirty-three patients (32%)(95%CI:23–42%) required advanced techniques for filter removal, and there were no major procedural complications (0%)(95%CI:0–3%). Median follow-up occurred at 344 days (range:3–1570) days after filter retrieval. CONCLUSIONS: No cases of life-threatening post-op PE occurred in this cohort of high-risk bariatric surgery patients receiving prophylactic IVC filters in combination with mechanical and chemoprophylaxis. The risk of filter-related complications was low and retrieval success was high with adjunctive use of advanced techniques. CLINICAL TRIAL REGISTRATION: NCT01158482