Intra-operative ultrasound guidance of vena caval umbrella placement in a super obese patient

Morbidly obese patients are often denied the benefits of sophisticated diagnostic studies and interventions because of the maximum weight limits of available equipment. Two examples in our hospital include a limit of 227 kg (500 lb) on our CT and angiographic tables. We present a patient who was considered to be high risk for recurrent pulmonary emboli and who could not undergo preoperative vena caval umbrella placement, because his weight exceeded the limit of our angiographic table. Intraoperative placement of the umbrella was accomplished by ultrasound localization of the device. We offer this alternative as an adjuvant in the armamentarium of the bariatric surgeon.