Pulmonary Embolism Averted

A 55-year-old morbidly obese male (body mass index 54) underwent placement of a prophylactic inferior vena cava (IVC) filter before a laparoscopic sleeve gastrectomy. Preoperative lower extremity venous duplex examination was negative for deep vein thrombosis. He was discharged home on postoperative day 3 after the bariatric procedure and had an uneventful recovery. Approximately 7 weeks later, he underwent an attempt at IVC filter retrieval. A repeat lower extremity venous duplex examination at that time was again negative for deep vein thrombosis. Cavography at the time of attempted retrieval demonstrated thrombus adherent to and trapped in the middle of the IVC filter, with a flow void that extended to the level of the hepatic veins (Figure 1A; online-only Data Supplement Movie IA). The filter retrieval was aborted, …