Publications by authors named "S Evola"

62 Publications

Trans-limb embolization for treatment of Type 2 endoleak post EVAR: Case report.

Int J Surg Case Rep 2021 Aug 26;85:106238. Epub 2021 Jul 26.

Vascular Surgery Unit - AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.

Introduction: Type 2 endoleaks (T2EL) occur after 10%-25% of endovascular abdominal aortic aneurysm repairs and increase the risk factor of endograft repair failure and rupture. Herein we report a case of endovascular treatment of T2EL where we performed a trans-limb embolization.

Presentation Of Case: A 63-years-old male previously treated for AAA with endovascular aortic aneurysms repair (EVAR), showed an angio-CT scan followup with a type 2 endoleak fed from inferior mesenteric artery (AMI) with growth of AAA greater of 1 cm than preoperative CT-scan and increase of chronic lumbar pain. Due to high risk of rupture was performed a trans-limb embolization with complete sealing. The 6 months CT-angiography showed complete type 2 endoleak exclusion without changes of AAA.

Discussion: The risk of aneurysm rupture in the presence of an isolated T2EL is exceptionally low. However, when a persistent T2EL is associated with a significant sac size increase, commonly considered as at least 5 mm over 6 months, should be treated. Detachable coils are repositionable, allowing an extremely precise deployment and subsequent embolization of different targets.

Conclusion: In this experience trans-limb embolization was feasible and this tool should be taken in account especially when no other surgical options exists.
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http://dx.doi.org/10.1016/j.ijscr.2021.106238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349994PMC
August 2021

Penetrating aortic ulcer post migration of thoracic aortic endoprosthesis: Case report.

Int J Surg Case Rep 2021 Aug 20;85:106219. Epub 2021 Jul 20.

Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.

Introduction: Thoracic endovascular aortic repair (TEVAR) is the first treatment option for many thoracic aortic pathologies. Especially after aortic dissections, it is possible to have progression during follow-up with appearance of new lesions on arterial wall. Herein, we report a case of Penetrating Aortic Ulcer (PAU) post release of Thoracic endoprosthesis.

Presentation Of Case: A 67-years-old male with hypertension and diabetes mellitus was followed at our hospital after an emergency procedure for Type B aortic dissection (TBAD) complicated by symptomatic large infrarenal AAA and treated with a proximal TEVAR plus chimney for left subclavian artery and PETTICOAT with EVAR for abdominal aortic disease. Follow up at 15 months showed a deep PAU with partial crush of stent in Left Subclavian Artery. Thus, we performed a left carotid-subclavian bypass and subsequently a TEVAR procedure with release of Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States).

Discussion: In literature there are few studeis that focus on migration after TEVAR during follow-up. Elongation, changes of tortuosity on thoracic aorta after TEVAR, can help to determine a migration of prosthesis. In this case Bolton Relay endoprosthesis (Terumo Aortic, Sunrise, Florida, United States) has permitted to improve precision and quality of procedure.

Conclusion: In literature there are few studies reporting complications of TEVAR post prosthesis migration. In this case, Bolton Relay endoprosthesis was useful and safe.
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http://dx.doi.org/10.1016/j.ijscr.2021.106219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339335PMC
August 2021

Transcervical approach for carotid artery stenting with transitory reversal flow: Case report.

Int J Surg Case Rep 2021 Aug 17;85:106206. Epub 2021 Jul 17.

Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy.

Introduction: Carotid artery stenting (CAS) has been indicated as an alternative to carotid endarterectomy in high risk patients. Sometimes, an aortic arch can be anatomically unfavourable for CAS. Herein we report our experience in a case of CAS with transcervical approach.

Presentation Of Case: A 77-year-old male was referred to our hospital for severe subtotal occlusion of the left internal carotid artery. He had a past medical history of radiation to the head and neck for laryngeal cancer. Previous CT-angiography had shown a type III aortic with bovine arch. CAS via transcervical approach was performed with transitory reversal flow during the placement of RX Spider Filter 6 Fr (Medtronic, Minneapolis, MN). After release of 7 × 30 mm RX Xact carotid stent (Abbott Vascular, Chicago, IL) and ballooning with a 5.5 × 30 mm Rx Submarine balloon catheter (Medtronic Minneapolis, MN), angiography check showed a good result.

Discussion: The transcervical approach is an innovative technique where usually a shunt is created, either between the common carotid artery and the internal jugular vein or between the common carotid artery and the common femoral vein. This flow reversal reduces the risk of periprocedural embolic events. In our experience a short proximal clamping with transitory reversal flow, reduces the invasiveness of procedure with good outcomes.

Conclusion: Transcervical carotid access with transitory reversal flow is a valid alternative in complicated patient with anatomy unfit for CAS.
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http://dx.doi.org/10.1016/j.ijscr.2021.106206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335628PMC
August 2021

[Cardiovascular health in Asian immigrants to Italy: risk factors, pathogenesis and pharmacological treatment].

G Ital Cardiol (Rome) 2021 Mar;22(3):203-211

U.O.C. Cardiologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza (ProMISE) "G. D'Alessandro", A.O.U. Policlinico Paolo Giaccone, Università degli Studi di Palermo.

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the western world has occurred due to several factors, such as economic crisis, political instabilities, persecutions and wars. It is well established that South Asians (SA) have a higher prevalence of coronary artery disease (CAD) and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both SA residing in their birth country and in those residing abroad, but it may also be due to the new spatial environment in which they live. We have found a higher prevalence of traditional cardiovascular risk factors in SA compared with other populations; in particular abdominal obesity, caused by an unhealthy diet rich in refined carbohydrates and saturated fats, plays a key role in the development of insulin-resistance, diabetes, dyslipidemia and hypertension, leading to the increase risk of CAD in SA. Even emerging risk factors were found to be higher in this ethnic group; indeed, the evidence of higher levels of pro-thrombotic and pro-inflammatory factors, such as lipoprotein(a) and pro-inflammatory adipokines, as well as the influence of air pollution and psychosocial stress, may have consequences on the risk, treatment and outcomes of CAD in this population.
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http://dx.doi.org/10.1714/3557.35340DOI Listing
March 2021

Catheter-based closure of a large atrial septal defect with inferior rim deficiency using pulmonary vein slide-out assisted implantation technique: a case report.

Eur Heart J Case Rep 2021 Feb 8;5(2):ytab016. Epub 2021 Feb 8.

Invasive Cardiology Unit, Centro Cardiologico Monzino, IRCCS University School of Milan, Italy.

Background: Transcatheter approach for large and complex atrial septal defects may represent a therapeutic challenge, particularly when the postero-inferior rim is deficient and floppy.

Case Summary: Here, we describe a successful catheter-based closure of a large (>30 mm) secundum atrial septal defect associated with postero-inferior rim deficiency in a 35-year-old female with congestive heart failure using pulmonary vein slide-out assisted implantation technique.

Discussion: Inferior-posterior rim deficiency is a well-known risk factor for device instability or embolization. Transcatheter closure may represent a safe and effective alternative to the traditional surgical approach provided that modified implantation techniques are employed.
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http://dx.doi.org/10.1093/ehjcr/ytab016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898564PMC
February 2021
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