Department of cardiac muscle pathology and transplantation of organs and tissues

Chronic thromboembolism

Chronic thromboembolism of the pulmonary artery

Thromboembolism of the pulmonary artery (TEPA) is a pathological condition in which thrombi or emboli get into the pulmonary artery system, preventing normal gas exchange and circulatory system in general.


More than 90% of TEPA cases are associated with the detachment of floating thrombus of varicose veins of the inferior vena cava system ( of lower limbs, femoral iliac segment and plexus of the pelvic organs). The risk factors of TEPA are old age, family history, obesity, cardiovascular pathology, dehydration, phlebitis. Oncological, hematological, autoimmune and some genetic diseases can also contribute to the development of this complication. Massive trauma, surgical interventions, prolonged immobilization and administration of certain medications increase the possibility of TEPA occurrence in persons from risk group.


Chronic TEPA is a consequence of multiple small focal thromboembolisms with the formation of postinfarction sclerotic lesions and of the lung parenchymal fibrosis. Clinically manifested by the syndrome of "unmotivated dyspnea," which occurs suddenly, without any apparent cause. Nothing else disturbs patient. With time, the insufficiency of the pulmonary heart is developing as in pulmonological pathology. But this is not related to chronic heart or lung diseases, it is a consequence of recurrent TEPA episodes.


  • X-ray study of thoracic organs, multislice spiral CT with contrast enhancement, angiopulmonography;
  • Laboratory studies (D-dimer, transaminases, LDH, coagulation profile, INR)
  • ECG, echocardiography;
  • Perfusion lung scintigraphy;
  • Identification of risk factors and concomitant pathology, which can provoke thrombus formation.


The main direction in the treatment of chronic TEPA is the detection and correction of conditions that can theoretically cause thrombosis.  Thrombolysis can be carried out during an attack in the absence of contraindications. But most often direct and indirect anticoagulants are used, as well as a basic therapy for the prevention of TEPA. For people with frequent relapses, the question of the surgical placement of a cava filter that prevents the passage of thrombi into the pulmonary artery system should be decided.



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