BACKGROUND:Pulmonary embolism (PE) is a leading cause of mortality after bariatric surgery. We evaluated inferior vena cava (IVC) filter use for PE risk reduction in high-risk super morbidly obese bariatric surgery patients. METHODS:IVC filters were inserted according to the patient's risk factors, including immobility, previous deep venous thrombosis (DVT)/PE, venous stasis, and pulmonary compromise. All filters were placed concomitant to bariatric surgery and were placed through a right internal jugular vein access site. We analyzed the prospectively collected data from this cohort and evaluated the incidence of PE and complications. RESULTS:Since April 2003, 41 patients (12 men and 29 women) with a mean age of 47.3 +/- 10.0 years and body mass index of 64.2 +/- 12 kg/m2 (range 47-105) underwent IVC filter placement. These and all other patients underwent standard DVT/PE risk reduction measures. All IVC filter patients had one or more significant risk factors for thromboembolic events. No instances of PE were documented, although 1 patient experienced DVT, and no immediate or late complications related to filter placement occurred. One patient, with a body mass index of 105 kg/m2, died secondary to rhabdomyolysis after an extended procedure. The average filter placement time was 34.3 +/- 9 minutes. CONCLUSION:IVC filter placement for PE risk reduction is safe and feasible in the super morbidly obese. Our data have shown that the filters can be placed expeditiously and with minimal morbidity concomitant with bariatric surgery. In this limited series, IVC filter placement was associated with no PE. Additional studies are needed to confirm the efficacy of IVC filter placement for PE risk reduction and related mortality in the super morbidly obese.

译文

背景:肺栓塞(PE)是减肥手术后死亡的主要原因。我们评估了下腔静脉滤器(IVC)在高风险,超级病态肥胖减肥手术患者中降低PE风险的使用。
方法:根据患者的危险因素插入IVC过滤器,包括不动,先前的深静脉血栓形成(DVT)/ PE,静脉淤滞和肺部损害。所有过滤器均与减肥手术同时放置,并通过右颈内静脉进入部位放置。我们分析了该队列的前瞻性收集数据,并评估了PE和并发症的发生率。
结果:自2003年4月以来,对41例平均年龄为47.3 /-10.0岁,体重指数为64.2 /-12 kg / m2(范围47-105)的患者(12例男性和29例女性)进行了IVC过滤器置入。这些患者和所有其他患者均接受了标准的DVT / PE降低风险措施。所有IVC滤过器患者均具有一个或多个血栓栓塞事件的重要危险因素。尽管有1例患者经历了DVT,但没有记录到PE病例,也没有发生与滤器放置有关的即刻或晚期并发症。一名体重指数为105 kg / m2的患者在延长手术后死于横纹肌溶解症。过滤器的平均放置时间为34.3 /-9分钟。
结论:在超级病态肥胖者中,IVC过滤器放置可降低PE风险是安全可行的。我们的数据表明,过滤器可以快速放置,并且与肥胖手术相伴的发病率极低。在这个有限的系列中,IVC过滤器的放置与没有PE相关联。需要更多的研究来确认IVC滤器放置对于降低超级病态肥胖患者PE风险和相关死亡率的功效。

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