Thromboendarterectomy

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What is a thromboendarterectomy?

female doctor showing chest xray to mature female patient in hospital bed

A thromboendarterectomy is a major surgery to treat thromboembolic pulmonary hypertension. This serious disease is due to blood clots (emboli) that lodge in the pulmonary arteries over a long period of time. They cause scar tissue and blockage of arteries and can lead to heart failure and death. A thromboendarterectomy involves removing the blood clots and scar tissue to restore normal blood flow to the lungs. 

A thromboendarterectomy is a complex, major surgery with serious risks and potential complications. You may have other treatment options. Consider getting a second opinion about all your treatment choices before having a thromboendarterectomy. 

Other procedures that may be performed

Your doctor will likely place an inferior vena cava (IVC) filter before the thromboendarterectomy. The filter traps new blood clots and prevents them from reaching the lungs. 

Placing a filter is a separate, minimally invasive procedure. It involves passing a tube (catheter) with the filter on the tip through a vein in the neck or groin into the inferior vena cava. The inferior vena cava is a large vein in the abdomen that carries blood to the heart and lungs.

Why is thromboendarterectomy performed?

Your doctor may recommend a thromboendarterectomy to treat thromboembolic pulmonary hypertension. This serious disease is due to blood clots (emboli) that lodge in the pulmonary arteries and cause scar tissue and blockage of arteries. This blocks blood flow to the lungs resulting in high blood pressure (hypertension) in the lung. Thromboembolic pulmonary hypertension can lead to heart failure and death. A thromboendarterectomy can cure this life-threatening disease and prevent fatal problems.

Your doctor will only recommend thromboendarterectomy if you are a good candidate for this surgery.  Not all pulmonary emboli need surgical treatment. Your doctor may recommend a thromboendarterectomy for:

  • Blood clots that cannot be dissolved with “clot buster” medication

  • Chronic blood clots, occurring over weeks to months

  • Moderate to severe pulmonary hypertension

  • Serious symptoms, such as chest pain, shortness of breath, and passing out

Ask your doctor about all of your treatment options and consider getting a second opinion.

Who performs thromboendarterectomy?

A highly specialized thoracic surgeon performs thromboendarterectomy. Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs, and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.

Thoracic surgeons who perform this complex and technical surgery have additional expertise beyond standard thoracic surgery training.

How is thromboendarterectomy performed

Your thromboendarterectomy will be performed in a hospital. This extensive and complex surgery takes eight to ten hours and involves a large specialized surgical team. 

Your surgeon will make a large incision in your chest and through the breastbone (sternum) to see and access the lungs area directly. Your surgeon will use a heart-lung machine (cardiopulmonary bypass) to take over the heart’s job of pumping blood during surgery. 

Your blood will be cooled as it passes through the machine. This cools your whole body to prevent organ damage when the machine is turned off temporarily. Turning off the machine gives your surgeon the best view of the lungs to remove the blood clots and scar tissue. 

Your body is then rewarmed and you are taken off the heart-lung machine.   

Type of anesthesia 

Your surgeon will perform thromboendarterectomy using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. 

You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

What to expect the day of your thromboendarterectomy

The day of your surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your medical history and your anesthesia

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of thromboendarterectomy?

As with all surgeries, thromboendarterectomy involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. 

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing

  • Bleeding, which can lead to shock

  • Blood clot, such as development of a deep vein thrombosis (DVT) in the leg or pelvis. A DVT can travel to your lungs causing a pulmonary embolism.

  • Infection and complications related to it

Potential complications of thromboendarterectomy

Complications of thromboendarterectomy include:

  • Inability to remove enough scar tissue

  • Kidney failure

  • Pulmonary artery damage

  • Swelling of lung tissue from a sudden, large amount of new blood flow

Reducing your risk of complications

You can reduce the risk of some complications by following your treatment plan and:

  • Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my thromboendarterectomy?

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for thromboendarterectomy by:

  • Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a echocardiogram, ventilation-perfusion nuclear scan, CT scan, chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.

  • Losing excess weight before the surgery through a healthy diet and exercise plan

  • Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

  • Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

  • Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before thromboendarterectomy and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need thromboendarterectomy? Are there any other options for treating my condition?

  • How long will the surgery take? When can I go home?

  • What restrictions will I have after the surgery? When can I return to work and other activities?

  • What kind of assistance will I need at home?

  • What medications will I need before and after the surgery? How do I take my regular medications?

  • How will you treat my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular office hours.

What can I expect after my thromboendarterectomy?

Knowing what to expect can help make your road to recovery after thromboendarterectomy as smooth as possible. 

How long will it take to recover?

Patients remain asleep for about three days after thromboendarterectomy. This allows the lungs to adjust to the new blood flow in a safe way. You will have drains in your chest for several days to drain excess fluid from around the lungs.

You may have a sore throat when you wake up from the tube that was in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. 

You will need several tests before you go home to check heart function and how well you are getting oxygen into your lungs and body. Your surgeon will discharge you home when your test results are normal or acceptable, your vital signs are stable, and there are no signs of complications.

Recovery after surgery is a gradual process. Recovery time varies depending on your condition before surgery, your general health, your age, and other factors. You will probably need supplemental oxygen for several months as your lung recovers. 

Tell your surgeon about all your activities and follow all instructions for returning to them. Full recovery takes several months.

Will I feel pain?

Pain control is important to healing and a smooth recovery. There will be discomfort after your surgery, including pain of the breastbone (sternum) as it heals. Your doctor will treat your pain or discomfort so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in because it may be a sign of a complication.

When should I call my doctor?

It is important to keep your follow-up appointments after thromboendarterectomy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

  • Bleeding

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion

  • Chest pain, chest tightness, chest pressure, or palpitations

  • Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's instructions about when to call for a fever.

  • Inability to urinate or have a bowel movement

  • Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot

  • Numbness or weakness on one side of your body or face, or severe headache

  • Pain that is not controlled by your pain medication

  • Sudden confusion, problems with speaking or memory, vision problems, dizziness, trouble walking, or loss of balance

  • Unexpected drainage, pus, redness or swelling of your incision

How might thromboendarterectomy affect my everyday life?

Thromboendarterectomy may cure thromboembolic pulmonary hypertension and improve your quality of life. Most people breathe easier and have increased energy and exercise endurance and normal or near-normal blood pressure in the pulmonary arteries.

You will need to see your doctor regularly and take anticoagulation medication (blood thinners) for the rest of your life to prevent blood clots. Some people still need therapy to control pulmonary artery blood pressure. They generally experience improvement in symptoms and quality of life as well.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Nov 11
  1. Pulmonary Thromboendarterectomy. Pulmonary Hypertension Association. https://www.phassociation.org/CTEPH/PTESurgery
  2. Pulmonary Thromboendarterectomy. The Society of Thoracic Surgeons. http://www.sts.org/node/2259
  3. Pulmonary Thromboendarterectomy (PTE). UC San Diego Sulpizio Cardiovascular Center. http://heartcenter.ucsd.edu/pte/Pages/default.aspx
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