BARIATRIC SURGERY (A. GHAFERI, SECTION EDITOR) Imaging Modalities for Detecting Deep Venous Thrombosis After Bariatric Surgery Franco Verde 1 • Oludare Alabi 2 • Gregory Prokopowicz 3 • Kimberley Eden Steele 4 Published online: 27 October 2018 Ó Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Purpose of Review Deep venous thrombosis (DVT) remains a leading cause of morbidity and mortality in the bariatric patient. We review the current non-invasive modalities—Doppler ultrasound (DUS), computed tomo- graphic venography (CTV) and magnetic resonance venography (MRV)—for the detection of DVT in the post- bariatric surgical patient. Recent Findings CTV and MRV are highly sensitive non- invasive imaging modalities with improved capability over DUS of detecting proximal, especially pelvic, DVT. MRV has recently been shown to be capable of detecting asymptomatic pelvic DVT in post-bariatric surgical patients. The clinical significance of these findings remains uncertain. Summary Invasive contrast venography, while remaining the gold standard, has been supplanted by DUS in routine clinical use. However, DUS has technical limitations in the morbidly obese patient. CTV and MRV remain highly accurate in this population and warrant further investiga- tion for routine clinical use. Keywords Obesity Á Bariatric surgery Á Venous thromboembolism (VTE) Á Deep vein thrombosis (DVT) Á Doppler ultrasound (DUS) Á Magnetic resonance venography (MRV) Introduction Disease Burden The obesity epidemic continues to rise in the US, with one in three people meeting criteria for obesity [1, 2]. Bariatric surgery has proven superior for sustained weight loss when compared to diet, pharmacological therapy, intensive life- style modification, cognitive behavioral therapy, or com- bination therapy [3–5]. However, bariatric surgery has well-known complications. In addition to direct surgical complications, postoperative venous thromboembolism (VTE) may occur, with a reported 2.2% incidence [6]. The incidence of symptomatic deep venous thrombosis (DVT) has been reported at 0.6% whereas asymptomatic DVT at 2% [4, 7]. Pulmonary embolism (PE) remains the leading cause of mortality in patients undergoing bariatric surgery, accounting for 38% of all deaths post-operatively [8]. This article is part of the Topical collection on Bariatric Surgery. & Kimberley Eden Steele ksteele3@jhmi.edu Franco Verde fverde1@jhmi.edu Oludare Alabi oludarealabi@rcsi.ie Gregory Prokopowicz gprokop@jhmi.edu 1 The Johns Hopkins University School of Medicine, Department of Radiology – Diagnostic Radiology, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224, USA 2 Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Dublin, Ireland 3 The Johns Hopkins University School of Medicine, Department of General Internal Medicine, Johns Hopkins Hospital, 601 N. Caroline St., Suite 7157, Baltimore, MD 21287, USA 4 The Johns Hopkins University School of Medicine, Department of Surgery, The Johns Hopkins Center for Bariatric Surgery, 4940 Eastern Ave, Baltimore, MD 21224, USA 123 Curr Surg Rep (2018) 6:24 https://doi.org/10.1007/s40137-018-0219-4