There are three types of angiography for assessing whether a patient with a confirmed diagnosis of CTEPH is suitable for pulmonary thromboendarterectomy (PTE) surgery, also known as pulmonary endarterectomy (PEA).
Pulmonary angiography (digital subtraction angiography) is considered the gold standard for confirmation of CTEPH and evaluation of operability1
Defines extent and distribution of disease and helps distinguish operable from inoperable disease1
Combined with right heart catheterization (RHC), a correlation can be made between degree of disease and degree of hemodynamic impairment2,3
The procedure should always be carried out by experienced staff at a unit with specialist pulmonary hypertension (PH) experience, preferably the unit at which PTE surgery would be performed2,3
Courtesy of the PTA Program at University of California, San Diego
Courtesy of Dr. Nick Kim, University of California, San Diego.
Blue arrows: Proximal chronic thromboembolic disease involving both descending pulmonary arteries in this patient with CTEPH. Red arrow: Bronchial collateral vessel visible in this region of proximal chronic obstruction.
Provides further information regarding diagnosis and operability, such as an evaluation of right-heart hemodynamics2,3
Noninvasive technique does not involve exposure to radiation, so it is suitable for repeated studies2,3
Note: Limited availability; may prove expensive and time consuming2,3
“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.”1
Watch as Dr Bill Auger of the PTE Program at UCSD reviews important considerations in evaluating CTEPH patients’ eligibility for potentially curative PTE surgery.
1. Kim NH, Delcroix M, Jenkins DP, et al. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62(suppl D):D92-D99. 2. Wilkens H, Lang I, Behr J, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): updated recommendations of the Cologne Consensus Conference 2011. Int J Cardiol. 2011;154(Suppl 1):S54-S60. 3. Jenkins D, Mayer E, Screaton N, Madani M. State-of-the-art chronic thromboembolic pulmonary hypertension diagnosis and management. Eur Respir Rev. 2012;21(123):32-39.