Society For Clinical Vascular Surgery

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Contemporary Experience with Inferior Vena Caval Filtration in Morbid Obesity Surgery
Nicholas J. Gargiulo, III, MD FACS RPVI RVT RDMS1, Frank J. Veith, MD FACS RPVI RVT RDMS2, David J. O'Connor, MD FACS RPVI RVT3, Jonathan Wong, MD FACS4.
1The Brookdale Hospital and Medical Center, New York, NY, USA, 2NYU and The Cleveland Clinic, New York, NY, USA, 3Hackensack University Medical Center at UMDNJ, Hackensack, NJ, USA, 4Northwell Health, New York, NY, USA.

OBJECTIVES: It has been previously suggested 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. This has not been observed in patients undergoing laparoscopic gastric bypass. Little is known regarding the necessity of IVC filter placement in patients undergoing robotic gastric bypass surgery. METHODS: Over a 3 year period, 51 morbid obese patients have undergone robotic gastric bypass procedures, and 37 (72.5%) had a BMI > 55 kg/m2. All 51 patients had routine preoperative subcutaneous lovenox injections and systemic compression devices prior to the administration of general anesthesia. Robotic gastric bypass was completed utilizing the da Vinci system. RESULTS: Fifty of 51 (98%) patients remained free of thrombo-embolic phenomena over the 3 year period (range 6 months-3 years) following successful robotic gastric bypass with the da Vinci system. One patient (2%) with a BMI > 55 kg/m2 developed a pulmonary embolism (PE) 1 month post procedure. She was treated successfully with intravenous heparin and had complete resolution of the PE. She was incidentally diagnosed with a Factor V Leiden deficiency and placed on long-term oral anticoagulation. CONCLUSIONS: It appears that IVC filter placement at the time of robotic gastric bypass is not required even in patients with a BMI > 55 kg/m2. A note of caution should be exerted in those obese patients who have a hypercoagulable disorder. 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.

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