Pulmonary thromboendarterectomy (PTE) is a complex surgery to remove long-term blood clots from arteries in your lungs that can’t be treated with medication. These blockages occur due to chronic thromboembolic pulmonary hypertension (CTEPH), a rare complication in people who’ve had blood clots in their lungs. In most cases, treatment is successful.
Pulmonary thromboendarterectomy (PTE) is a complex surgery to remove chronic blood clots from arteries in your lungs when medication isn’t successful. In many cases, with early diagnosis, PTE can successfully cure the condition.
Pulmonary thromboendarterectomy is also called pulmonary endarterectomy (PEA).
Surgeons use pulmonary thromboendarterectomy (pronounced “thrombow-end-arter-ectomee”) to treat blockages in people with chronic thromboembolic pulmonary hypertension (CTEPH). This condition is a rare but potentially life-threatening complication that may occur in people who have had pulmonary embolisms (PEs, blood clots in their lungs).
With CTEPH, one or more old blood clots get caught in the walls of your pulmonary arteries (arteries in your lungs), blocking the blood flow. In most cases, these blockages respond to blood-thinning medication.
But if the clots don’t respond to medication, it can lead to scar tissue, which causes increased blood pressure in your lungs and makes breathing difficult. CTEPH can also cause small vessels in your lungs to become narrow and stiff.
PTE is the only treatment that can potentially cure CTEPH. Left untreated, CTEPH can lead to heart failure, lung damage and even death.
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If you have CTEPH, you may be eligible for pulmonary thromboendarterectomy depending on:
If the clots can be safely removed, healthcare providers consider PTE the treatment of choice. But about 40% of people (4 out of 10) aren’t good candidates for PTE.
Many people aren’t eligible for PTE because of the complexity of the surgery. During the procedure, your surgical team uses cardiopulmonary bypass machine, which takes over the job of your heart and lungs and provides your body with oxygen.
PTE also involves periods of cooling your body to stop brain function, which then allows the stoppage of all blood circulation (deep hypothermic circulatory arrests). This process removes blood from the surgical site, giving your surgeon visibility (ability to see) into the arteries of your lungs so they can remove the scar tissue. The cooling protects your brain from neurological damage during the procedure.
If you're not eligible for PTE, your healthcare provider may recommend another treatment to open your pulmonary arteries, including:
Researchers don’t know the exact number of people with CTEPH. Around 2% to 4% of people with a history of pulmonary embolus will go on to develop CTEPH. They believe CTEPH is significantly underdiagnosed, and people end up with severe symptoms before receiving treatment.
Healthcare providers perform an estimated 400 PTEs each year in the United States.
Your healthcare provider will let you know how to prepare for your procedure, including whether you need to fast or stop taking any medications.
Follow your healthcare provider’s guidelines for:
You receive anesthesia for the procedure, which generally starts early in the morning and lasts for about six hours.
During PTE, your surgical team:
After PTE, you’ll go to the intensive care unit (ICU), where you’ll remain overnight. The next morning, your medical team will give you a breathing test. If you’re able to breathe on your own, they’ll remove the ventilator.
You typically stay in the hospital for about seven to 10 days. You start your recovery in the ICU and move to an intermediate level of care as soon as possible, often the day after surgery.
Recovery is similar to recovery from open heart surgery. You may start walking within a few days and slowly start doing more. You’ll also have some tests, including a test to find out how much oxygen you’ll need after you go home.
PTE is the only way to cure chronic thromboembolic pulmonary hypertension (CTEPH). The surgery is successful in most cases, leading to improved breathing, lung function and ability to be active. Most people who were on oxygen before surgery can come off after surgery, and damage to their right heart from the disease is often reversed. Long-term survival is excellent after surgery.
The risk of PTE has decreased dramatically over the last year, and the risk of not surviving the surgery is now as low as 1% in most people. The risk of stroke is 1% to 2%.
After PTE, some people will still have some degree of pulmonary hypertension, or PH that recurs, and may require medications.
In some cases, pericardial effusion (fluid buildup around your heart) develops after surgery. You may experience:
If you experience these symptoms, call 911 or go to the nearest emergency room. Talk to your healthcare provider about any other symptoms you experience after PTE.
You can get back to your regular activities over time. But you can’t drive, work or lift anything heavier than 10 pounds for at least six weeks after surgery. From week seven to week 12, you can lift up to 25 pounds. After 12 weeks, there aren’t any restrictions.
In most cases, you can return to your routine within three months of surgery. Your breathing and ability to exercise typically improve and may continue to improve for up to four years after surgery.
You need to have follow-up visits and tests to check your lungs. These tests are usually six weeks and three to six months after surgery. You also need to take anticoagulants (blood thinners) to prevent clots for the rest of your life.
Call your healthcare provider if you have:
A note from Cleveland Clinic
Pulmonary thromboendarterectomy (PTE) is surgery to remove blood clots and scar tissue from the arteries in your lungs. It can cure chronic thromboembolic pulmonary hypertension (CTEPH) — and potentially save your life. It’s a complex procedure that involves a recovery process similar to open heart surgery. But PTE often offers a chance to breathe better, live longer and enjoy the activities you love.
Last reviewed by a Cleveland Clinic medical professional on 07/15/2022.
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