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PTE assessment

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
pulmonary thromboendarterectomy (PTE) surgery, also known as pulmonary endarterectomy (PEA).

Pulmonary angiography

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

pulmonary angiography image

Courtesy of the PTA Program at University of California, San Diego

CT angiography

  • Provides additional information regarding diagnosis and
    operability (eg, giving information on arterial walls)2,3
  • Helpful in determining whether there is evidence of surgically
    accessible CTEPH2,3
  • High-quality multidetector computed tomography pulmonary
    angiography (CTPA) may be a suitable alternative to pulmonary
    angiography in centers with experience in CTEPH1
  • Note: Normal CT angiography does not exclude a diagnosis of


CT angiography image

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.

MRI angiography

  • 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



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.