[Color duplex ultrasound-guided foam sclerotherapy: an approach in the of lower extremity management of patients with superficial varicosities]

Background: Duplex ultrasonography guided foam sclerotherapy is now considered as standard option in varicose vein treatment; it is conducted as an outpatient procedure, does not require general ansthesia and compared with surgery results in an earlier return to normal activities. However, for treatment several sessions may be required

Aim of Work: The objective of this study is to cribe the efficacy, results and safety of DCU foam sclerotherapy for treating superficial venous ase of the lower limbs

Patients and Methods: 80 patients [28 males, 52 females] who were diagnosed to have clinical and radiological evidence of lower extremities venous diseases in the department of Vascular Surgery AT Assiut University Hospital from March 2012 to May 2014 were included. Their ages ranged from 18 to 57 years. Local ethics committee approval and written informed consent were obtained. To be considered suitable for UGFS all patients treated with UGFS the foam was prepared by Tessari's method. Any residual veins treated with another session

Results: Eighty patients presenting with symptomatic varicose veins of superficial system. There were52 females [65%], and 28 males [35 %] with a mean age of 55.76 +/- 9.67. CEAP grades of patients were as follows; [60.0%] in C2, [10.0%] in C3, [21.25%] in C4 [2.5%] in C5 and [6.25%] in C6. The affected segments of the superficial system which were treated were ; [70.0%] great saphenous, [17.5%] small saphenous, [6.25%] were great saphenous vein and varies and [6.25%] small saphenous vein and varies. The numbers of sessions needed to eradicate the affected segment were one session in [70%], two sessions in [18.75%] and three in [11.25%].Minor complications encountered were skin discoloration in 30% of patients, superficial thrombophlebitis in 16% and an allergy to the foam sclerosant in 2.5%. After one year follow up by CDU [70%] had complete occlusion, [15%] had partial occlusion and [80%] of patients showed improvement of CEAP classification

Conclusions: UGFS is a safe and effective treatment as an alternative to surgical treatment for superficial system varicosities. One and infrequently two to three treatment sessions, to complete eradication of superficial reflux in virtually 100% of cases. It is considered as an outpatient procedure. Complications are few, and appear mostly self-limiting

Approach to surgical management of carotid body tumor and our experience at Assiut University Hospital

Carotid body tumor [CBT] is a rare neoplasm, which typically presents as a slow growing, painless neck mass found along the anterior border of the sternocleidomastoid muscle. This tumor is generally benign but possesses aggressive resection remains a surgical challenge traditionally associated with a 15-30% incidence of cranial nerve injury. To present our experience at Assiut University Hospital regarding surgery of CBT and the use of preoperative embolization and mandibulotomy in large sized tumors. The study was performed on 18 cases with CBT, 5 females and 13 males with a mean age of 40 years. Clinical and radiological diagnosis was recorded. Angiography was done in 17 cases for confirmation of CBT diagnosis and its extent, evaluation of carotid arteries and for preoperative emobilization. One case due to some technical difficulties was evaluated by spiral CT angiography. Patients were classified according to the tumor size and Shamblin classification. Preoperative imobilization to decrease the tumor vascularity and the intraoperative blood loss, was done. Patients were subjected to surgical removal of the tumor through anterior longitudinal approach to the carotid system not later than 4 days after the embolization to avoid the inflammatory phase and the development of any collaterals. Paramedian mandibulotomy was done in cases with very large tumore. Patttients presented with painless swelling, local tenderness, bruit, difficulty with swallowing, and hoarseness. Preoperative embolizaiton for large cases decreases the tumor vascularity by [25% to 45%][as documented by post embolization films. The average blood replacement was one unit. There were no deaths and complications were recorded in 44.4% of patients as vascular complications [legation of external carotid artery, simple repair of internal carotid artery, and repair of internal carotid artery with interposition of vein graft] or neurological complications as cerebrovascular stroke, injury of vagus, hypoglossal and marginal mandibular nerves. All cases were confirmed histologically as benign paragangliomas. CBT should be taken in considerations in all lateral neck masses. Angiograhy is very helpful in making the diagnosis. Preoperative embolizaiton decreases the tumor size, the vascularity and facilitates the subsequent surgery. Paramedian mandibulotomy provided a wide exposure, in cases with large sized tumors. Early detection and resection of smaller tumors ultimately reduced the risk of complications