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Pulmonary Thromboendarterectomy (PTE) Assessment

The three types of angiography for PTE assessment.

There are three types of angiography for assessing whether a patient with a confirmed diagnosis of CTEPH is suitable for PTE* surgery.

Pulmonary angiography

“Pulmonary angiography (digital subtraction angiography) remains the gold standard for confirmation of [CTEPH] and evaluation of operability.”3

  • Defines extent and distribution of disease and helps distinguish operable from inoperable disease.5,18
  • Combined with RHC, a correlation can be made between degree of disease and degree of hemodynamic impairment.5,18
  • The procedure should always be carried out by experienced staff at a unit with specialist PH experience, preferably the unit at which PTE surgery would be performed.5,18

CT angiography

  • Provides additional information regarding diagnosis and operability (eg, giving information on arterial walls.5,18
  • Helpful in determining whether there is evidence of surgically accessible CTEPH.5,18
  • High-quality multidetector CTPA may be a suitable alternative to pulmonary angiography in centers with experience in CTEPH.3
  • Note: Normal CT angiography does not exclude a diagnosis of CTEPH.5,18

MRI angiography

  • Provides further information regarding diagnosis and operability, such as an evaluation of right heart hemodynamics.5,18
  • Noninvasive technique does not involve exposure to radiation, so is suitable for repeated studies.5,18
  • Note: Limited availability; may prove expensive and time-consuming.5,18

“A CTEPH team, consisting of an experienced PTE surgeon and CTEPH physicians, should assess operability before alternative treatments are considered. Close working collaboration between community providers and CTEPH centers is required.”3

  • The Editorial Board dispels the myth that PTE* surgery can’t be done in obese patients. Watch the video to learn more.

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Learn more about patients with inoperable or recurrent CTEPH.

*Also called pulmonary endarterectomy or PEA.

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View additional information about patients with inoperable or recurrent CTEPH.

Pulmonary angiography remains the gold standard for confirmation of CTEPH.

Important Operability Assessment Considerations


Dr Bill Auger of the PTE Program at UCSD reviews important considerations in evaluating CTEPH patients’ eligibility for potentially curative PTE surgery (also known as PEA).

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