Operability Assessment & Surgical Treatment
PTE is the primary treatment for CTEPH.
Because pulmonary thromboendarterectomy* (PTE) is potentially curative, it is the primary treatment for patients with CTEPH.3
Not every patient is a candidate for surgery, though.
In a European CTEPH registry of 679 patients, published in 2011, 247 (36.6%) were deemed to have inoperable disease.8
The most common reason patients in this registry were considered to have inoperable disease was because the lesions were considered too distal or inaccessible.8
- Inaccessibility of occlusions, n=118/247
- Comorbidities, n=33/247
- Imbalance between increased pulmonary vascular resistance (PVR) and amount of accessible occlusions, n=25/247
- PVR>1500 dyn∙s∙cm-5, n=6/247
- Age, n=5/247
- Other, n=56/247
- Patients missing data, n=4/247
Every patient diagnosed with CTEPH should be evaluated by an expert CTEPH team, including CTEPH physicians and PTE surgeons, to assess their candidacy for PTE surgery.3
The CTEPH.com Editorial Board differentiates common myths and realities concerning PTE* surgery in older patients in this video.
PTE operability assessment is an inherently subjective exercise, and it depends very much on the experience and the skills of the CTEPH team and the PTE surgeon. Whenever feasible, seek an assessment from a second experienced CTEPH team if a patient is initially deemed to have inoperable disease.3
However, surgery or operability assessments are not the only referrals that should be made for patients with CTEPH. V/Q scan referrals are recommended for the early signs of CTEPH to ensure patients are properly diagnosed from the start.3
*Also called pulmonary endarterectomy or PEA.
View additional information about patients with inoperable or recurrent CTEPH.
Every CTEPH patient should be evaluated for PTE surgery by an expert team.
Key Steps in Performing PTE Surgery
In this video, Dr Michael Madani, of the PTE Program at UCSD, shows key steps—including extraction of thromboembolic material—in performing PTE surgery (also known as PEA).