Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

Abstract

BACKGROUND/AIMS:It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT). Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively) because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery.METHODS:We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs.RESULTS:No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%). One patient had a right lower limb venous ulcer.CONCLUSION:Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

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“…[ 10 ] We performed a study where we performed routine preoperative venous Doppler of 180 consecutive patients who underwent bariatric surgery and found that no patient had preoperative DVT and only 8% patients had superficial venous disease. [ 11 ] In our survey, routine preoperative venous Doppler was not preferred by >90% of surgeons.…”

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“…In fact, the placement of IVCFs was associated with higher rates of DVT and mortality. 17,18 We suggest that these modalities would not be useful for the EGS patient and would delay treatment and increase the cost.…”

Thromboelastography Values Remain Hypercoagulative 6 Months After Obesity Surgery: a Pilot Study

“…In obese individuals, there is an up to five fold increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) with increasing body mass index (BMI) [1]. There are many explanations for this elevated risk such as inactivity, altered venous hemodynamics, and chronically elevated intra-abdominal pressure as well as endothelial dysfunction and hypercoagulability related to excess adipose tissue [5,6]. Hormones and cytokines produced by adipocytes induce a procoagulant and proinflammatory state, both of which may also play a role in thromboembolic events [2,[7][8][9].…”

“…Furthermore, obesity is associated with lower limb venous diseases, which further predispose patients to DVT [5]. Obese patients may also have other etiologies for impaired venous return from the lower limbs such as chronically raised intra-abdominal pressure, inactivity, and immobility related to osteoarthritis [6].…”