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Background : Peripherally inserted central catheters (PICCs) are commonly used in cancer patients, however there is wide variability in the rates and management of PICC-associated upper limb venous thromboembolism (PaULVTE). Aims : To determine the incidence, risk factors and treatment practices for PaULVTE in patients with cancer receiving chemotherapy. Methods : A retrospective chart review of consecutive patients with haematological or oncological malignancies, who received chemotherapy and had their first PICC insertion from April 2017 to July 2018 at Monash Health, Melbourne. The primary outcome measure was the incidence of PaULVTE. Secondary outcomes were PaULVTE treatment, whether an intermediate to high Khorana score (KS) could predict PaULVTE and other VTE incidence. Results : 147 patients were included (69 males [47%]), median age 64 years (Table 1)). Haematological malignancies (27%) comprised mainly lymphoma (n=33, 22%) whilst solid organ malignancies included colorectal (n=40, 27%) and gastric (n=18, 12%). Symptomatic PaULVTE events were observed in 10 patients (7%, 3.6-12.2% 95% CI, 0.8 per 1000 catheter-days, 40% haematological malignancy, 7 involved the axillary and internal jugular veins, 3 basilic and cephalic veins). All patients with deep PaULVTE (axillary/subclavian veins) were therapeutically anticoagulated, resulting in one major bleed. PICC retention was 20% despite 66% retaining function. Non deep PaULVTE were treated with PICC removal despite ongoing function (67%) or observation alone (33%). All PaULVTE occurred in those with intermediate to high KS (11%, 95%CI 5-18%) versus low KS 0% (95%CI 0-10%, p=0.06). A further 7 (5%, 95%CI 2-10%) patients developed VTE (PE/LLDVT) deemed unrelated to the PICC. There were no deaths due to VTE or its treatment. Conclusions : In patients with active malignancies receiving chemotherapy, 7% experienced PaULVTE. Despite the majority of patients' PICCs retaining function and patients receiving therapeutic a

Background : Peripherally inserted central catheters (PICCs) are commonly used in cancer patients, however there is wide variability in the rates and management of PICC-associated upper limb venous thromboembolism (PaULVTE). Aims : To determine the incidence, risk factors and treatment practices for PaULVTE in patients with cancer receiving chemotherapy. Methods : A retrospective chart review of consecutive patients with haematological or oncological malignancies, who received chemotherapy and had their first PICC insertion from April 2017 to July 2018 at Monash Health, Melbourne. The primary outcome measure was the incidence of PaULVTE. Secondary outcomes were PaULVTE treatment, whether an intermediate to high Khorana score (KS) could predict PaULVTE and other VTE incidence. Results : 147 patients were included (69 males [47%]), median age 64 years (Table 1)). Haematological malignancies (27%) comprised mainly lymphoma (n=33, 22%) whilst solid organ malignancies included colorectal (n=40, 27%) and gastric (n=18, 12%). Symptomatic PaULVTE events were observed in 10 patients (7%, 3.6-12.2% 95% CI, 0.8 per 1000 catheter-days, 40% haematological malignancy, 7 involved the axillary and internal jugular veins, 3 basilic and cephalic veins). All patients with deep PaULVTE (axillary/subclavian veins) were therapeutically anticoagulated, resulting in one major bleed. PICC retention was 20% despite 66% retaining function. Non deep PaULVTE were treated with PICC removal despite ongoing function (67%) or observation alone (33%). All PaULVTE occurred in those with intermediate to high KS (11%, 95%CI 5-18%) versus low KS 0% (95%CI 0-10%, p=0.06). A further 7 (5%, 95%CI 2-10%) patients developed VTE (PE/LLDVT) deemed unrelated to the PICC. There were no deaths due to VTE or its treatment. Conclusions : In patients with active malignancies receiving chemotherapy, 7% experienced PaULVTE. Despite the majority of patients' PICCs retaining function and patients receiving therapeutic a

Aim: To determine anatomical variations of superficial veins of cubital fossa. Background: The cubital fossa Veins lie superficially in the subcutaneous tissue and not paired with any artery, they are easy to view and access. The superficial veins include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries. The knowledge of superficial venous distribution of the cubital fossa is important, not only from an anatomical-clinical and surgical point of view, but also anthropologically and biologically. Materials and Methods: The study done on120 males and 30 females were randomly selected from among the rural area of central India which also include the students and staff members of J.N.M. College Sawangi Wardha (M.S.) 150 cases of right upper limbs and 150 cases of left upper limbs. After taking the subject's consent, the superficial veins of the cubital fossa were made prominent by using tourniquet. The patterns of cubital veins were marked on skin and photograph are taken. Results: the patterns of arrangement of superficial cubital vein observed are as follow. Type I –MCoV joining with the CV and BV in 51%., type II CV bifurcating intoMBV and MCV which join BV and ACV respectively, Type III-MVF bifurcating in MBV and MCV 9.66%., Type IV- 7.66%subjects of present study the CV terminates in to BV and ACV runs separately, In Type V- 3% of subjects the CV communicating directly with BV and ACV was absent and Type VI –A large single CV ascending upwards without any communication with other veins. 3 of 300 subjects i.e. 1%. Conclusion: Numerous studies in different races and ethnic groups have shown similarities and differences in the deposition of the superficial veins of the cubital fossa. Various procedure should be perform with caution bearing in mind the anatomical variation present in these region.

Aim: To determine anatomical variations of superficial veins of cubital fossa. Background: The cubital fossa Veins lie superficially in the subcutaneous tissue and not paired with any artery, they are easy to view and access. The superficial veins include the cephalic, basilic, median cubital, and antebrachial veins and their tributaries. The knowledge of superficial venous distribution of the cubital fossa is important, not only from an anatomical-clinical and surgical point of view, but also anthropologically and biologically. Materials and Methods: The study done on120 males and 30 females were randomly selected from among the rural area of central India which also include the students and staff members of J.N.M. College Sawangi Wardha (M.S.) 150 cases of right upper limbs and 150 cases of left upper limbs. After taking the subject's consent, the superficial veins of the cubital fossa were made prominent by using tourniquet. The patterns of cubital veins were marked on skin and photograph are taken. Results: the patterns of arrangement of superficial cubital vein observed are as follow. Type I –MCoV joining with the CV and BV in 51%., type II CV bifurcating intoMBV and MCV which join BV and ACV respectively, Type III-MVF bifurcating in MBV and MCV 9.66%., Type IV- 7.66%subjects of present study the CV terminates in to BV and ACV runs separately, In Type V- 3% of subjects the CV communicating directly with BV and ACV was absent and Type VI –A large single CV ascending upwards without any communication with other veins. 3 of 300 subjects i.e. 1%. Conclusion: Numerous studies in different races and ethnic groups have shown similarities and differences in the deposition of the superficial veins of the cubital fossa. Various procedure should be perform with caution bearing in mind the anatomical variation present in these region.

The need for a secondary source of venous drainage in deep inferior epigastric artery perforator flaps is common, with the cephalic vein Commonly utilized as an alternative venous recipient vessel. In using the cephalic vein, previous studies have described the deltopectoral groove or the infraclavicular fossa as the site for harvest. We describe the use of an anterior axillary skin crease, which can improve aesthetic outcome, reduce the time needed for harvest, enable a greater length of vein to be transposed, and minimize surgical insult to the upper breast/chest wall. An anterior axillary-line skin fold can be used as the site for cephalic vein harvest, and using the methodology described, the technique can be fast and highly reliable and result in a final scar that is barely visible.