The incidence of symptomatic PICC-associated UE DVT is low, but given the number of PICCs placed each year, they account for up to 35% of all diagnosed UE DVTs. Larger-diameter PICCs and malignancy increase the risk for DVT, and further studies are needed to evaluate the optimal vein of first choice for PICC insertion.

Lower extremity DVT is common in critically ill trauma patients, particularly in the first week following injury, regardless of injury pattern, DVT risk factors, or pharmacologic prophylaxis. Previous studies have underestimated DVT rates by not investigating CVDVTs and not exclusively targeting critically ill patients. We recommend early and continued DUS DVT screening of all critically ill trauma patients.

In patients with prior DVT, perioperative symptomatic recurrence is common and is associated with high-risk procedures. A longer time interval between a DVT episode and subsequent surgery may decrease the risk of recurrence, but large clinical trials are needed to confirm this. Further prospective evaluations are needed to identify and treat patients at greatest risk for recurrence.

Results: Technical success rate was 96.6%. Clinical success was 83.0%. Within 30 days postoperatively, 6.2% required repeat intervention; 4.2% required amputation; 3.3% experienced postoperative complications, including bleeding requiring transfusion (1.1%), thromboemboli (1.0%), infection (0.7%), respiratory complications (0.4%), and myocardial infarction (0.1%); and 3.3% died. Patency, limb salvage, and survival rates are listed in the Table. Conclusions: The combination of thrombolysis and laser atherectomy is safe and effective in treating TASC C and D lesions in this high-risk group of patients with critical limb ischemia.Objective: American Chest Physician (ACP) guidelines stratify DVT risk in trauma patients based on injury pattern and medical prophylaxis. Screening is recommended only for the highest risk groups. Many screening studies for DVT have not investigated calf vein DVT (CVDVT) and did not exclusively target critically ill patients. Given new ACP guidelines recommending treatment of calf vein DVT, we investigated the efficacy of duplex ultrasound (DUS) screening of critically ill trauma patients for all lower extremity DVTs, including CVDVT, regardless of injury pattern, risk factors, or medical prophylaxis.Methods: The records of 264 intensive care unit trauma patients who received DUS screening for lower extremity DVT were examined for data on high-risk injuries, DVT risk factors, and LMWH prophylaxis.Results: DUS screening found DVT in 40 patients (15.2%), of which 25 (62.5%) were CVDVT, and 30% of all DVTs were diagnosed Յ1 week of admission. Patients without high-risk injuries receiving LMWH had a 13.5% DVT rate, which did not differ significantly from the 19.7% DVT rate in high-risk injury patients not receiving LMWH (P ϭ .667). Patients without high-risk injuries who received LMWH had high rates of DVT, even excluding other DVT risk factors.Conclusions: Lower extremity DVT is common in critically ill trauma patients, particularly in the first week after injury, regardless of injury pattern, DVT risk factors, or medical prophylaxis. Previous studies have underestimated DVT rates by not investigating CVDVTs. We recommend early DVT screening of all critically ill trauma patients. JOURNAL OF VASCULAR SURGERY Volume 52, Number 2Abstracts 525

Methods: An effort to increase BB utilization was implemented in 2003 at 11 centers participating in the Vascular Study Group of New England (VS GNE). A 90% target was set and feedback given at bi-annual meetings. BB usage (Ͻ 1-mo preoperative (P) vs chronic (C)) and POMI rates were prospectively collected among patients undergoing open AAA repair (n ϭ 926) and lower extremity bypass (n ϭ 2123) from 2003 through 2008. Predictors of POMI were determined using multivariate logistic regression. Rates of BB utilization and POMI were analyzed over time across strata of patient risk based on a multivariate model.Results: Overall BB utilization was 86% (AAA 90%, LEB 84%, p Ͻ 0.001), and in-hospital POMI occurred in 5.5% of patients (AAA 7.6%, LEB 4.6%, p Ͻ 0.001). P-BB usage increased in low risk and C-BB usage increased in medium/high risk pts, but POMI rates did not change over time (table). Age Ͼ70 (OR 2.1), positive stress test (OR 2.2), CHF (OR 1.7), C-BB (OR 1.7), resting heart rate (HR) Ͻ 70 (OR 1.8) and diabetes (OR 1.6) were independent predictors of POMI. Resting HR was 67, 70, 70 for patients on C-BB, P-BB and no BB.Conclusions: Despite regional improvement in BB usage, POMI rate did not decrease, perhaps due to P-BB doses that did not change HR. A negative impact of C-BB on POMI was unexpected and requires further investigation.Objectives: PICC line placement may be complicated by superficial (SVT) or deep vein thrombosis (DVT). The purpose of this study was to determine if any PICC line characteristics were associated with venous thrombotic complications.Methods: All upper extremity venous duplex scans over a 12-month period were reviewed, selecting patients with isolated SVT or DVT, and recently placed PICC lines (Ͻ 30 days). Patient characteristics, PICC insertion sites, and technical specifications were evaluated. Over the same period, PICC usage patterns were determined from an electronic medical record query.Results: Over the 12-month period, 690 patients underwent upper extremity venous duplex scans, revealing 219 isolated SVTs and 154 DVTs. Concurrently, 685 PICC line procedures were reviewed (74% basilic, 16% brachial vein, 10% cephalic). 44 of 219 (20%) isolated SVTs were associated with a PICC line (32% cephalic, 68% basilic). 54 of 154 DVTs (35%) were associated with a PICC line. Basilic vein PICCs accounted for 45 DVTs (83%) and brachial vein PICCs for 9 (7.5%), but there were no DVTs associated with cephalic vein PICC lines. (p ϭ 0.03)Conclusions: PICC lines placed in the cephalic vein are associated with isolated SVT, while those placed in the basilic vein are more frequently associated with SVT and DVT. The cephalic vein should be preferentially utilized for PICC line placement to minimize the risk for iatrogenic DVT formation.