The use of intravascular ultrasound imaging to improve use of inferior vena cava filters in a high-risk bariatric population

Abstract

This study suggests efficacy of IVUS-guided IVC filter placement in preventing mortality from pulmonary embolism in high-risk bariatric patients, including the super-obese. IVUS-guided IVC filter placement can be safely performed with an excellent success rate in all bariatric patients, including the super-obese, who otherwise would not be candidates for IVC filter placement due to the limitations imposed by their large body habitus.

The efficacy of prophylactic IVC filters in gastric bypass surgery

“…In contrast to Birkmeyer et al, all studies that were included in our analysis stated that IVCF are safe and should be considered in high-risk patients undergoing bariatric surgery [1,6,11,[13][14][15][16]26]. One of these studies that advocated the use of prophylactic IVCF had a prospective part in their study design [12].…”

“…In our and in Rajasekhar and Crowther's review, there was an overlap of reviewed articles. [1,6,11,[13][14][15][16] However, we excluded any studies that investigated bariatric procedures other than gastric bypass surgery, because of different patient characteristics, as well as different length and technical complexity of each procedure. In addition, we attempted to compare the outcome of laparoscopic and open gastric bypass surgery, which showed no difference in the rate of PE, but, interestingly, a trend towards higher rate of major complications and DVT in the laparoscopic group, despite a slightly higher mortality in the open group.…”

“…Small retrospective studies and one partly prospective comparative study have suggested its clinical use in high-risk patients over the last 8 years. [1,6,[13][14][15][16]26] This resulted in a tremendous increase in the use of prophylactic IVCF before bariatric surgeries. Larger prospective studies have not been conducted to support this practice, and millions of dollars are being spent annually for a questionable procedure.…”

“…[1,2,6,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] We identified 12 retrospective studies about the prophylactic use of IVCF in bariatric surgery. [1,2,6,7,[10][11][12][13][14][15][16]26] One of the studies also had a prospective part in its study design. [11] In addition, one prospective study was found [17].…”

“…Patient data were analyzed for eight of the 13 studies. [1,6,11,[13][14][15][16]26] The following five studies were excluded from our data analysis:…”