History was made by Dr. Eugene Tanquilut at Advocate South Suburban Hospital recently as Dr. Tanquilut performed the first-ever remote endarterectomy at the Hospital, using LeMaitre MollRing Cutter® Transection Device on Chicago Heights resident Peter Caffarelli.
Remote Endarterectomy, or RE, combines both vascular (traditional) surgery techniques and endovascular (more innovative and less invasive) techniques. Because Dr. Tanquilut is board certified in both vascular and endovascular surgery, he is the only surgeon in the Chicago Southland able to perform this hybrid procedure.
Caffarelli, 57, was diagnosed with peripheral artery disease (PAD), a condition in which plaque, a mix of fat, cholesterol, calcium, tissue and other elements, builds up in the arteries causing atherosclerosis, hardening of the arteries. As plaque builds within the arteries, the blood flow becomes restricted, making it more difficult for oxygenated blood to reach the tissues, muscles and bones that need it. PAD typically affects the arteries in legs, but can also cause problems in those that supply blood to the head, arms, kidneys and stomach. In some cases, patients may never know they have PAD, as other blood vessels take over for the affected arteries. In others, PAD can be a painful, often life-threatening condition.
Caffarelli had for years been experiencing pain. “Mostly in my lower leg, under the knee,” he said. “I dealt with the pain for about a year and then it got a lot worse. I couldn’t do the stairs anymore and I had to hire a guy to mow my lawn.”
This type of pain, which worsens with walking and then improves with rest, is called intermittent claudication. Claudication may include numbness, aching or heaviness, or cramping in the legs, buttocks or feet. Because blood vessels are narrow or blocked, muscles cannot get the oxygen needed during activity. The pain disappears when resting because muscles do not need as much oxygen.
“I finally brought it up to my primary care doctor Dr. (Paul) Chemello,” said Caffarelli, “and he told me, “I got a good guy” and referred me to Dr. Tanquilut.”
“I explained my pain to Dr. Tanquilut and he looked at my leg and set up a test immediately,” said Caffarelli. After a 30-minute, minimally invasive angiogram which showed the extent of Caffarelli’s severe blockage, Dr. Tanquilut presented him with three options.
“We saw complete blockage of the femoral artery above Peter’s knee. Peter’s condition could be treated with traditional bypass, with stenting, or the RE, which is as good as a bypass for longevity and is minimally invasive,” said Dr. Tanquilut. “After giving Peter all the information about each procedure, the decision was made collaboratively to do the RE. Peter was a very good candidate for the procedure, given his condition.”
“With RE, we maintained Peter’s own artery, there was less risk and a faster recovery than with traditional bypass. A small incision was made into Peter’s artery at his groin. We then inserted the MollRing Cutter, a flexible rod with a little ring at the end. With this tool, we were able to transect the total blockage, cut it out without any harm to the artery itself and then pull it back out of the artery. We then inserted a Gortex® stent to allow the smooth flow of blood again within the artery. From the angiogram, I knew Peter had substantial blockage, which measured at about 25 centimeters (nearly 10 inches),” said Dr. Tanquilut.
Caffarelli said, “Dr. Tanquilut talked to me after surgery and was very happy with the results. It’s really great knowing he loves his work that much.”
“Despite the severity and length of the blockage, by a small incision, we were able to get excellent results. Peter was walking very soon after surgery; he’s had almost no down time,” said Dr. Tanquilut. “I’m very pleased that we were able to get such good results through this university-level, minimally invasive modality.”
Cafarelli spent one night in ICU at Advocate South Suburban Hospital. “I was very comfortable there, but when I saw Dr. Tanquilut the next day, he asked me if I’d rather be at home and of course I said yes. I was home by one o’clock that afternoon.”
PAD is a serious condition that increases the risk of stroke, heart attack, transient ischemic attacks or “mini-strokes” and coronary heart disease. Because blood flow is restricted, if untreated, PAD can also cause ulcers and wounds that will not heal, leading to gangrene and possible limb amputation. Depending upon the severity of symptoms, PAD can be treated with lifestyle changes, medication, minimally invasive procedures or surgery. Pain or numbness in arms or legs, sores that are healing slowly or not at all, a lower temperature in one leg or arm, or a pale or bluish color in toes, feet, fingers or hands are all symptoms that should be brought to a doctor’s attention immediately. Erectile dysfunction can also be a symptom of PAD.
Caffarelli’s long term prognosis is very good. He takes a low-dose blood thinner as a prophylactic measure and is back to a normal active life.
Caffarelli doesn’t think it was a big deal that he was making Advocate South Suburban history. “From my first appointment, I have trusted Dr. Tanquilut”, said Caffarelli. “Some people just rub you that way- you know how people just hit you that way? He explained things to me, and he said “when we are done, you will not have any more pain” and that’s what I wanted. He was very nice and so is his whole staff – nurses, the assistants, the girls at the counter.”
Dr. Tanquilut grew up in Orland Park and graduated from Carl Sandburg High School. He earned his Bachelors degree at University of Illinois and his D.O. at Midwestern University College of Osteopathic Medicine. He and his partner at Vascular Specialists, Dr. Sanjeev Pradhan, are the only two physicians in the Chicago Southland who have extensively trained and are board certified in both vascular and endovascular surgery. Dr. Tanquilut trained at the prestigious Cleveland Clinic’s Heart and Vascular Institute, ranked for 21 years in a row as No. 1 by U.S. News & World Report. He can perform RE at Advocate South Suburban Hospital in Hazel Crest, Silver Cross Hospital in New Lenox and Franciscan St. James in Olympia Fields. Vascular Specialists has offices in Olympia Fields and New Lenox.
To others who suffer PAD symptoms, Caffarelli says, “Oh, most definitely I’d recommend Dr. Tanquilut – without a doubt. I don’t have the pain anymore. I walk up and down the stairs to do my laundry and it doesn’t bother me, I get around much better without pain. I can walk outside. I am just about 100% without pain. I highly recommend him – I thank Dr. Tanquilut for what he’s done for me.”
