An asymptomatic Lima dissection after a programmed hybrid revascularization procedure turned to nightmare.

A 71-year-old female with symptomatic bitroncular coronary ischemic disease was admitted in our hospital for hybrid revascularization. She presented significant stenosis of the proximal and middle left anterior descending artery (LAD) and of the second segment of right coronary artery (RCA). She was scheduled for an Endoscopic Atraumatic Coronary Artery Bypass (EACAB) of the left internal mammary artery (LIMA) to LAD and staged percutaneous coronary intervention (PCI) to RCA after the EACAB. Control of LIMA permeability after RCA PCI showed LIMA dissection with TIMI 2 flow to LAD. Decision to stent a freshly implanted LIMA led to LIMA rupture. An emergent LAD revascularization with a saphenous vein graft and control of bleeding was successfully performed. Patient was discharged at day 10 from the hospital.

Evaluation of the perceptions and cosmetic satisfaction of breast cancer patients undergoing totally implantable vascular access device (TIVAD) placement.

PURPOSE: Totally implantable vascular access devices (TIVADs) are widely used to administer chemotherapy to cancer patients. While great progress has been made with respect to breast surgical reconstruction to take into account both aesthetics and patients' perceptions of body integrity, these aspects have not been considered with regard to the impact of TIVAD. In order to address this practice gap, we have adapted our TIVAD implantation technique to improve cosmetic results. The aim of this study was to assess breast cancer patients' comfort level and aesthetic satisfaction with regard to TIVAD insertion. METHODS: Patients with breast cancer admitted for chemotherapy at an outpatient clinic completed a previously validated survey evaluating three main domains: symptoms (pain, discomfort) related to the TIVAD itself in daily activity, information received before and during the surgical procedure, and cosmetic aspects regarding the port insertion site (scar, port, and catheter location). RESULTS: Between September 2010 and June 2011, 232 patients were evaluated. Cosmetic satisfaction with scar location was high (93.3 %). Information given to patients before and during the procedure had a major impact on both symptom perception in daily activity and on cosmetic satisfaction. CONCLUSIONS: Obtaining a more aesthetic scar by placing the TIVAD in the deltopectoral groove contributed to a high rate of cosmetic satisfaction. Furthermore, the relevance of information given to patients before and/or during surgery had a major impact on symptom perception. Therefore, we suggest including a pre-operative information session in the care pathway.