– Daniel Greer didn’t realize that he was becoming part of medical history when Dr. Sanjeev Pradhan of Vascular Specialists used a newly FDA-approved device to repair Greer’s multiple aneurysms at Advocate South Suburban Hospital in Hazel Crest. Greer just knows it worked.
The device, called a GORE® EXCLUDER® Iliac Branch Endoprosthesis, or Modular Aorto-Iliac Stent, was the first ever used anywhere within the Advocate Healthcare System and one of the first used in the Chicagoland area.
“The specialized aorto-iliac stent was approved in the first quarter of 2016 and Daniel was a perfect candidate,” said Dr. Pradhan. “At 79, Daniel is still active, overall very healthy and should have many vibrant years ahead of him.”
The Park Forest native was following up with his primary care physician Dr. Dwayne Buchanan after a 2014 cancer incident when Dr. Buchanan recommended an abdominal aortic artery screening. Greer had smoked for years, was a male over 65 years of age, and was experiencing some slight discomfort in his abdomen. “Dr. Buchanan thought as a precaution, I should have the CT scan,” said Greer.
The scan came back showing multiple aneurysms in both the abdominal aortic artery and his pelvic arteries, also known as the iliac arteries. An aneurysm is a weak spot that bulges in an artery. That weakened spot may continue to grow and then rupture, which is usually fatal. Most people with an abdominal aortic aneurysm (AAA) may never have symptoms, and the first indication of the condition could be a deadly rupture. As in Daniel’s case, AAA typically occurs in patients over 65 years of age. Other risk factors include smoking, being male, having high blood pressure and a family history of AAA. A screening is recommended for everyone over the age of 65.
“Daniel’s condition was advanced, with his iliac artery aneurysms measuring 4 centimeters, about the size of a baseball. There was a 100% chance that these aneurysms would rupture within a year,” said Dr. Pradhan.
Dr. Pradhan examined the CT, reviewed Greer’s medical history and determined he was a very good candidate for the new iliac stent. Because of the location of the aneurysms, before the new iliac stent was approved for use, a case like Daniel’s would require embolization of the iliac branch; the blood flow to this important artery would be stopped permanently. Because the iliac branch is the pelvis’ main blood supply, this causes several life-changing complications, including muscle damage to the buttocks and upper leg, resulting in pain and disability, and a stoppage of blood flow to the pelvis, resulting in erectile dysfunction.
Previously, open surgery could be performed, preserving the iliac artery, and the outcomes were just acceptable, notes Dr. Pradhan. “There were, though, many other complications. Patients experienced deep vein thrombosis, pelvic pain, bleeding complications, and erectile dysfunction.”
“Formerly, there was just no good way to preserve the internal iliac artery when placing an endograft. With the new device, we can keep all the arteries open, keep the blood flowing and keep Daniel living as he should. This system eliminates all those complications, saving the blood flow to the pelvis.” said Dr. Pradhan.
Jack DiBennedetti of GORE has worked with Dr. Pradhan and Dr. Eugene Tanquilut, both of Vascular Specialists, for nearly a decade. DiBennedetti works alongside these physicians before and during the procedures. “These stents are unique. The concept is to preserve the iliac branch with a dedicated device. Formerly, a surgeon could do a makeshift procedure but they were not good for the long term,” said DiBennedetti. “This new iliac stent is really a big deal. It solves the problem of repairing abdominal aortic aneurysm along with iliac aneurysm without stopping blood flow to the pelvis.” More often than not, surgeons will see these conditions together in the same patient.
DiBennedetti notes that patients who require this procedure are younger and younger, and preserving their mobility and functionality gets more and more important. “We can safely treat patients who we may not have treated before; we can address broader anatomies.” Because 80-85% of AAA cases are now treated endovascularly, these designs can treat younger patients, with far greater success.
Dr. Pradhan and DiBennedetti assessed the CT scans prior to Greer’s surgery. They analyzed each artery’s measurements and determined which specific stents to provide in the procedure. “These stents are not custom made, so they can be in our hands within 24 hours. Each artery will have a different diameter, so the stents are then built within the patient.” DiBennedetti hails 3-D imaging as a tremendous help in determining the correct stent sizing for each patient and each artery. “These are very patient specific.”
DiBennedetti was also present during Greer’s procedure, to help with any device questions from Dr. Pradhan or his team.
Dr. Pradhan then consulted with Greer and his family to explain the procedure and the new device. “Dr. Pradhan recommended I take no chances, that a rupture – if I made it through – could be very dangerous. He explained that inserting the stent now would prevent a rupture and would prevent open surgery. He said it was a good choice, and better for my long-term health. My son’s wife said, let’s do this,” smiled Greer.
Greer checked into Advocate South Suburban Hospital for the endovascular surgery. “South Suburban Hospital has all the technology needed for this surgery,” said Dr. Pradhan. “They have the imaging technology and the endovascular tools for advanced procedures such as this.”
Dr. Pradhan used the iliac stent in conjunction with the GORE® EXCLUDER® AAA Endoprosthesis, or AAA stent. Dr. Pradhan and his team made a very small incision in each of Greer’s femoral arteries, at the groin where the legs meet the hips. He then inserted a delivery catheter on the right to place the AAA stent, and a delivery catheter on the left to place the iliac stent.
There are a total of four pieces that make up the mechanism; a trunk, a bridging component, an iliac branch stent and an internal iliac branch component. These pieces come together to resemble an upside-down tree with three branches. The trunk stent repairs the aortic aneurysm and the additional pieces repair lower aneurysms while keeping all the pelvic arteries open, adequately supplying this area with oxygenated blood. The procedure took less than two hours to complete.
Greer said, “I spent a few hours in the ICU, then went to a regular room for monitoring overnight. I got to go home the next day.”
Greer especially notes that Dr. Pradhan explained everything so thoroughly, he’s hardly had any questions, before or after the procedure and during his follow up appointments. “He gave me the reasons why he would do what he did, and explained it all. He’s got a good personality that I like, a good demeanor.”
A fierce advocate of patient education, Dr. Pradhan believes that every patient should be seeing a vascular and endovascular surgeon when facing aneurysm, vein or artery issues. “You should see a surgeon who can deal with your disease in a variety of ways so that, working together, the best choice of treatment can be made for you as an individual. Do your research, find out about latest technologies and devices. Ask your surgeon if he or she is comfortable using those and if they are recommended in your case. Your surgeon should be knowledgeable about new procedures.”
Dr. Pradhan notes with pride that the procedures done by Dr. Tanquilut and himself are university-level care. “There are even universities that are not doing these procedures. I have a great staff and team at Advocate South Suburban Hospital that assist me in performing these complex operations. They are intelligent, compassionate and share my passion for learning and helping patients.”
“This is an uncommon procedure,” agrees DeBennedetti. “And it’s the first implant of its kind in the Advocate System. I work with Dr. Tanquilut and Dr. Pradhan several times a month and these physicians are fantastic. They are both fellowship trained; Dr. Pradhan at Yale and Dr. Tanquilut at Cleveland Clinic, very prestigious programs.”
Dr. Pradhan grew up in Wisconsin and graduated from Northwestern University. He completed his medical degree at Medical College of Wisconsin and completed both his general surgery residency and vascular fellowship at Yale University School of Medicine. He lives in Orland Park.
“I feel it inside me,” said Dr. Pradhan. “I have a real need to increase my toolbox, adapt my approach with each new patient and consider new evidence as it becomes available. I don’t ever want to be comfortable with what I know. It’s passion, it’s knowledge and it’s skill. That’s where it all comes together for the patient’s benefit.”
Dr. Pradhan is joined by Dr. Eugene Tanquilut at Vascular Specialists, with offices in Olympia Fields and New Lenox. The two are the only physicians in the Chicago Southland who are board certified in both vascular and endovascular surgery.
“Dr. Tanquilut and Dr. Pradhan are skilled and qualified,” said DiBennedetti. “They have the knowledge to do the procedures properly. They have access to the right equipment, because Advocate South Suburban has all the proper imaging technology. Their demeanor and personalities are fantastic – they have great bedside manners. Their support staff is great. These guys do a lot of great work.”
Daniel Greer agrees. “‘I have no problems. My follow up was good. I’m exercising more and I quit smoking. Dr. Pradhan told me that these aneurysm were probably a direct result of my smoking for so long. I’m back to volunteering at the food pantry, cutting my lawn.” He smiles. “I feel great. And that’s kinda neat that I’ve made history.”
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