Introduction:Varicose vein is one of the most common vascular conditions in the adult population. Symptoms ranged from dilated and tortuous veins with fatigue, heaviness, and itching to more serious conditions such as skin discolouration and leg ulceration. 1 Multiple techniques for treating saphenous reflux have been developed over the years, such as high ligation at saphenofemoral junction, stripping of great saphenous vein, ultrasonogram guided sclerotheraphy, as well as various combinations of these procedures. Recently, endovenous laser ablation identified as a viable treatment option for patients with saphenous reflux. 2 Surgical treatment includes high ligation of the saphenous vein or high ligation and stripping of GSV. High ligation alone demonstrated a 43%-71% failure rate at 5years and high ligation and stripping of GSV had a 25%-60% failure rate, ranging from 5-34 years in the available literature. [3][4][5][6] The failures associated with high ligation alone stemmed from neovascularization that occurred in the saphenofemoral surgical bed and was attributed to the process of skeletenization and ligation of all tributaries of the saphenoferal junction. In the recurrences that occurred after stripping, the etiology may be incomplete removal of the entire vein. 2 The most common complication of high ligation and GSV stripping is paresthesia with others like infection, haematoma, bruising. Because of high failure rates and recurrences of Foam Sclerotherapy and Laser Ablation of Varicose Veins: Newer Option in Bangladesh Perspective

Background: Vascular access care is a classic example of multidisciplinary team work among nephrologists, vascular surgeons, duplex specialists, dialysis nurses and dialysis staff. The objectives of this study were to determine the complication of arteriovenous fistula (AVF) for hemodialysis (HD) and to find out the role of duplex study for the management of fistula complications. Methods: This was a prospective type of study done on 121 arteriovenous fistulas. All operations were done in different hospitals in Dhaka city. After duplex study of upper limb vessels, the site of fistula creation was determined. All Radio-cephalic, ulnar-basilic and brachiocephalic fistulas were done under local anesthesia. Other fistula of the series was done under brachial block. Immediate postoperative bruit, thrill and distal pulses were monitored. Fistulas were considered mature after at least 6 weeks of fistula creation with good visualization of arterialized vein and good thrill. Patients were advised to report if any complication arises. Results: The most common fistula was Radio-cephalic fistulas (72.73%) and then Brachio-cephalic fistulas (19.84%). The left upper limb was the first choice for fistula creation as a non-dominant limb. Most fistula was created in left upper limb (76.86%). The most common complication was stenosis of arterialized veins (4.13%) and another type of stenosis was found at anastomotic site (2.48%). Second most common complication was cannulation site infections (3.31%). Another common type of infection was found at the site of fistula creation (2.48%). Thrombosis, aneurysm and pseudoaneurysm were identified as the most detrimental complications. Conclusion: Arteriovenous fistula is an important issue for hemodialysis patient as the life line. Dialysis nurses and technician should have knowledge about antisepsis and potential complication of AVFs. Early diagnosis and early treatment prevent loss of vascular access and reduce serious morbidity and mortality. Both the patients and dialysis staffs should give highest care for the AVF to reduce the complications. Bangladesh Heart Journal 2020; 35(2) : 100-105

Introduction:Coronary artery disease is the most common form of heart disease and the single most important cause of premature death in the developed world. 1 Surgical management of IHD is coronary artery bypass graft surgery (CABG), which can be performed either under cardiopulmonary bypass (CPB) or by using off-pump technique. Impairment of pulmonary function after CABG is one of the most common complications in the early postoperative period. 2 Sternotomy, pleurotomy with opening of the pleural space, harvesting of internal mammary artery and pain may lead to deterioration of post-operative pulmonary function. In addition, the incidence of concurrent chronic lung disease is higher in the age group of patients who require revascularization of the myocardium. Combined these two factors indicate a need for documentation of pulmonary function pre-and postoperatively. 3 Coronary revascularization procedure is done usually through median sternotomy incision and for this; impairment of pulmonary function is one of the most significant post-operative complications of CABG. 4 For revascularization, emphasis is given over internal mammary artery (IMA) graft. The mediastinum and thoracic cavity are traumatized more with IMA than with reverse saphenous vein graft (RSVG) procedure. Indeed, some reports have found that IMA patients have worse pulmonary functions than the RSVG patients in the postoperative period. 5 Basal atelectasis develops early during anaesthesia and may persist in the post-operative period. After surgery both respiratory muscles