The purpose of the study was to determine the incidence and risk factors for venous thrombosis in patients with a peripherally inserted central catheter (PICC). A retrospective study of all upper extremity venous duplex scans was carried out in the Vascular Medicine department from year 2000 to 2002 inclusive. A chart review of positive scans was undertaken to identify possible thrombotic risk factors. Of 317 upper extremity venous duplex scans carried out, 115, or 32%, were positive for upper extremity deep vein thrombosis. Three main risk factors were identified - presence of a central line, malignancy and administration of chemotherapy. PICC were the most common central line present. Symptomatic thrombosis occurred in 7% of PICC inserted for chemotherapy compared with 1% of PICC inserted for other reasons. Ten per cent of the patients receiving chemotherapy through a PICC developed a thrombosis. The post-thrombotic syndrome was infrequent following upper extremity deep vein thrombosis. Patients receiving chemotherapy through a PICC are at increased risk of thrombosis. There may be a role for prophylactic low-dose anticoagulation in these high-risk patients.

Not reconstructing the resected thrombosed infrarenal inferior vena cava results in minor signs and symptoms of peripheral venous hypertension and only minor abnormalities on haemodynamic assessment.

Introduction Atherosclerosis is the most common abnormality seen in the vascular laboratory. Rarely, other arterial diseases, such as large vessel vasculitis, are seen. We describe our experience of Takayasu's arteritis (TA). Methods The clinical and duplex ultrasound findings of six patients with TA were analyzed. Common sites of involvement and the ultrasound appearances of TA were compared with typical findings of atherosclerosis. Results The mean age of the patients was 53 yr, and all were female. TA had been present for 11.8 yr (range, 1–27 yr). All six patients underwent upper extremity duplex scanning. In all cases, abnormalities were present in the proximal and mid common carotid arteries; however, the carotid bifurcation was normal in five of six cases. The proximal subclavian artery was abnormal in five of six cases. In addition, four patients had a severe stenosis in the distal axillary/proximal brachial artery. All of these abnormalities were situated distal to the origin of the subscapular artery. All patients underwent duplex scanning of the abdominal aorta. Severe stenotic disease was present in two patients, with one of these having had a previous aortic grafting procedure. Three additional patients had aortic wall thickening without stenosis. B-mode ultrasonography demonstrated homogenous, concentric, long arterial wall thickening in all areas of abnormality in all cases. Conclusions TA is an uncommon disease affecting the large branches of the aorta. The proximal and mid common carotid and the distal axillary arteries are commonly involved, and these sites are unusual in atherosclerosis. The detection of abnormalities on duplex scanning at these sites raises the diagnostic possibility of TA.

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