Retrievable Vena Cava Filters in High Risk Surgical Patients: A Study in Safety and Efficacy

Giancarlo Piano, MD, Erika R. Ketteler, MD, Vivek Prachand, MD, Erin DeValk, RN, Thuong G. Van Ha, MD, Bruce L. Gewertz, MD and John C. Alverdy, MD
University of Chicago Hospitals, Chicago, IL

Objectives: Retrievable vena cava filters (rVCFs) are being used more frequently peri-procedurally. However, the indications and safety profile for placement of retrievable preoperative vena cava filters (rVCFs) remains undefined. This study sought to determine the safety and efficacy of rVCFs in bariatric surgery patients who are known as a high-risk population for peri-procedural DVT and/or PE.
Methods: Protocols were developed at a tertiary referral hospital to place rVCFs in consecutive high-risk patients undergoing either laparoscopic gastric bypass or duodenal switch if they met any of the following criteria: BMI>55 kg/M², hypercoaguable state, or previous history of DVT or PE. Using both ultrasound and fluoroscopy, all rVCFs were placed immediately following general anesthesia just preceding the bariatric procedure. The internal jugular vein (IJV) was the preferred approach followed by the femoral vein (FV). Retrieval was performed after the 4^th postoperative week.
Results: Over 16 months, 60 rVCFs were placed out of 61 attempts, 57 via IJV and 3 via FV. Six patients refused retrieval attempt. Of the remaining 54 rVCFs, the primary retrieval success was 90% (49/54) with all failures due to filter tilt. The secondary retrieval success was 100% (3/3). The two remaining patients refused secondary retrieval attempt. The average dwell time of rVCFs was 63 days. There were no intra-operative complications in placement or retrieval. One patient developed a clinical PE with the filter in place while not receiving postoperative anticoagulation. There were no patient deaths. The average BMI of the patients was 61 kg/M².
Conclusions: Placement of retrievable vena cava filters in high-risk bariatric surgery patients is safe and offers potential clinical benefit to patients requiring short-term protection from pulmonary embolism.