– When Lynn Mead told his wife Shirley he wasn’t feeling well, she told him to “go lay down. He’s 86. Sometimes he just doesn’t feel good.” When she checked on him later that evening, “he was very sweaty and he was all crooked on the bed. I straightened him out and went to bed myself. He grunted a few times when I was moving him,” so she was a little concerned, but not really alarmed.
About thirty minutes later, Shirley heard a thud. “I went to the bedroom and he was laying on the floor, struggling to get up and he couldn’t talk. I got scared and called my son who told me to call 9-1-1. So I did.” The ambulance arrived at their Tinley Park home and took Lynn to Advocate South Suburban Hospital in Hazel Crest.
“My son and grandson met me in the Emergency Room. Lynn was unresponsive and I was just so scared.”
Advocate South Suburban Emergency Room staff ordered an immediate CT scan and the results were both rare and life-threatening. Lynn had suffered a large rupture of an abdominal aortic aneurysm, or an AAA, that had, amazingly, self-clotted.
The aorta is the body’s main blood supply and is about the diameter of an average garden hose. It runs from the heart down through the abdomen before splitting into the iliac arteries in the pelvis, which continue into the legs. When part of the aorta weakens, it enlarges, like that garden hose with a bulge, causing an aneurysm. Without screening, AAA goes undetected and when a rupture occurs, nearly 90% of patients die before any surgery can be performed. About 75% die before they even get to the hospital.
At the ER, “suddenly, out of nowhere, comes this doctor,” says Shirley. “Where did he come from? It was the middle of the night, I think 2 o’clock in the morning by this time, and he just appeared out of nowhere.”
That physician was Dr. Sanjeev Pradhan of Vascular Specialists. Unbeknownst to Shirley, South Suburban Hospital’s ER physicians and nurses had called Dr. Pradhan, sent him a digital copy of the CT scan and Dr. Pradhan had been organizing a life-saving surgery enroute to the Hospital from his Orland Park home.
“The quick diagnosis and action of the Advocate South Suburban Hospital ER staff was crucial to Lynn’s survival. Some people may think of South Sub as a community hospital, but this was university-level care. Lynn would not be with us without their prompt actions,” says Dr. Pradhan.
The CT scan showed Dr. Pradhan that Lynn was extremely and unusually fortunate. “His rupture had sealed itself, forming a tamponade, a clot that prevented his aorta from pumping his blood freely into his body’s abdominal cavity,” said Dr. Pradhan. “For the moment, it was keeping him alive, but that tamponade could break up at any moment. I needed to get Lynn into surgery immediately.”
“This surgery is one of the biggest of the big,” said Dr. Pradhan. “A surgeon without endovascular training might want to fix this with major open surgery, but that would break up the tamponade, increasing the bleeding, which could result in kidney failure, heart attack and immediate death. Given Lynn’s condition and the results on the CT, I wanted to provide him with an operation that treated the rupture without putting his life – and the subsequent quality of life – on the line.”
Because of Dr. Pradhan’s specialized fellowship training at Yale University and extensive experience with both vascular and endovascular surgery, he was able to quickly assess all options – both major surgery and minimally invasive surgery – to determine what would best suit Lynn’s unique condition.
Before he left for the Hospital, Dr. Pradhan used the CT scan to complete all necessary measurements of Lynn’s aorta. He then alerted Jack DiBennedetti from GORE Medical to join him and bring the properly sized stent device needed to insert and seal the ruptured aneurysm. From his car, Dr. Pradhan organized the OR team and the Interventional Radiology/Cath Lab team. The entire team was ready within an hour of the first call to Dr. Pradhan, so that when the physician entered the hospital, he was able to discuss the procedure with the Meads, get their approval and get into the OR.
“This rupture came out of nowhere,” says Shirley. “We had no idea and there were no symptoms. We go to the doctor of course, and nothing ever showed he had this.”
For years, abdominal aortic aneurysms have been known as silent killers. An aneurysm could go undetected and grow for years. “Previously, most victims died at home after experiencing the worst back pain ever,” said Dr. Pradhan.
Shirley says, “Dr. Pradhan told us that Lynn’s condition was very bad, very serious, that something had burst inside him. He explained what a ruptured abdominal aorta was, told us what he’d do in surgery. He was open and told us what he thought, right out.” Lynn was taken to surgery, and then the Meads waited.
“Lynn’s rupture was big, from an aneurysm that was probably about 10 cm, about the size of a softball,” says Dr. Pradhan. During the approximately two-hour surgery, Dr. Pradhan and his team made small, less than 1” long, incision intos Lynn’s groin to access his femoral arteries. Because of Dr. Pradhan’s expertise and knowledge, the team was able to use very little contrast dye during the procedure, less than 10cc, compared to a more typical 80cc. This helped protect Lynn’s kidneys from failing. Dr. Pradhan inserted the GORE Endoprosthesis stent, a combination of nitinol and a nickel titanium alloy scaffold that is covered with polytetrafluoroethylene or PTFE, a type of Teflon fabric. The stent was guided through Lynn’s body to his abdominal aorta and in effect, relined the ruptured area. DiBennedetti was present for the entire procedure, available to provide other materials if needed and ensuring that the stent was working as it’s designed to do.
“Having Jack in the surgery is helpful. He’s a great partner and he can help troubleshoot any issues, as he’s seen so many different surgeries,” said Pradhan.
“Dr. Pradhan came through the door and said Lynn had made it through the surgery. He was happy with the results,” said Shirley. “He showed us the scan before the surgery, which was all cloudy, and the new scan, which was so clear – there was a 100% difference.”
Lynn smiles and remarks that this is really Shirley’s story, “because I don’t remember a thing. I was out of it until I woke up after the surgery.”
Lynn spent the night in ICU. “His heart bounced back, his kidneys bounced back,” said Dr. Pradhan. “Lynn was up walking the next day.” Lynn’s recovery continued at South Suburban Hospital for a couple of weeks, and then he was released to a rehabilitation facility for 2 weeks of physical therapy.
Lynn followed up with Vascular Specialists, and his check-in CT scan “came out good”, says Shirley.
“He’s been okay ever since,” says Shirley. “His PT (physical therapy) is done, he’s raking leaves, he drives us to our doctor appointments, we go shopping. He’s back to all his regular activities. He’s doing good for his age. He is a little tired, but he is going to be 87 in November, you know.”
Patients who experience this type of repair have follow up CT scans one month after surgery, 6 months after surgery, one year after surgery and then annually after that. There is less than a 10% chance that Lynn’s stent might leak, but that would be repaired endovascularly as well. “These stents are strong and flexible,” said Dr. Pradhan. “They have no shelf life and should work forever.”
Risk factors for developing AAA are highest for older white males. Other factors include having hypertension or high blood pressure, a family history of AAA, atherosclerosis and, of course, smoking. Previously, there was limited opportunity for repair, as surgery was often more risky than monitoring the aneurysm. With the advent of endovascular techniques, that has changed.
Dr. Pradhan said, “The limitations are not there any longer as we continue to progress with endovascular innovations. Using different therapies, we can repair an aneurysm before it causes any trouble. If you have any of the risk factors, get screened. Get screened early in life if you have a genetic tendency to develop AAA. Everyone should get screened as soon as they turn 60, especially if you’ve ever smoked. Screening is a simple, painless and non-invasive ultrasound, so there’s no risk involved. It’s always better to know and take action than go through a rupture – because you might not make it through.”
Dr. Sanjeev Pradhan practices with Dr. Eugene Tanquilut at Vascular Specialists, with offices in Olympia Fields and New Lenox. Both physicians are uniquely qualified and outstanding in both the vascular and endovascular fields, providing evidence-based medicine, using the most recent published data and university level care. They are the only award-winning, fellowship trained, board certified vascular and endovascular surgeons in the Chicago Southland.
GORE representative DiBennedetti says, “I’ve worked with Drs. Pradhan and Tanquilut for years now and I can tell you, they are both highly trained surgeons. Both completed fellowships at very prestigious places; Pradhan at Yale and Tanquilut at Cleveland Clinic. They are skilled and qualified, very patient-specific in their practice. Their support staff is great. They also have access to the right equipment. South Sub is fully equipped for these types of surgeries. Besides, they have great personalities and great bedside manners.”
Shirley will attest to that. “I was so scared, so nervous,” she says of that time in the ER. “I thought ‘where am I and what is happening?’ Dr. Pradhan came out of nowhere. I had never met him before and he was sweet and cordial to us. I would tell everyone to go to Dr. Pradhan. He’s a wonderful surgeon and I’ll always stand by him. Dr. Pradhan hurried up and came like an angel through the night to help my husband.”
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