Angioplasty of Distal Lesions for Carriers of Inoperable Post-embolic HTP

Angioplasty of Distal Lesions for Carriers of Inoperable Post-embolic HTP

Currently, the standard treatment for proximal thromboses lesions responsible for post-embolic pulmonary hypertension, is the surgical thromboendarterectomy. When the ravages are judged too distal or the patient is judged inoperable for a curative surgical gesture, there is no evidence of any therapeutic option, exept for K anti-vitamins for recurrent embolism. Prognosis is then pejorative with a 60% mortality at 5 years.

This study propose an alternative treatment for these patients in therapeutic "dead end". This is about applying arterial thrombosis technique to the pulmonary circulation.

Inclusion Criteria:

• Patients over 18 years
• Patients with a pulmonary hypertension diagnosed by right catheterisation, with a mean arterial pressure >30 mmHg and arterial pulmonary resistance > 3 UW.
• Patients with group 4 (Dana point) pulmonary hypertension, thromboembolic.
• Chronic thrombosis visible to scanner, pulmonary IRM angiogram or to pulmonary angiogram.
• Patient's file refused by the reference center multidisciplinary coordination meetings for surgical thromboendartériectomy or refusal from the patient to be operate.
• Absence of counter-argument to the femoral venous or jugular way.
• Normal kidney function or moderatly degraded (clearance>30 mL) or dialysed renal failure
• Persons affiliated to national social security
• Signed free consent by patients

Exclusion Criteria:

• Pulmonary hypertension pos-embolic operated by thromboendarteriectomy
• Pulmonary hypertension Group 1 of Dana Point, meaning idiopathic, familial, post-anorectics, associate with a congenital heart disease associated to a scleroderma, associated to a chronic hemolytic disease
• Pulmonary hypertension Group 2 of Dana Point, associated with a left cardiovascular disease
• Pulmonary hypertension Group 3 of Dana Point, associated to a respiratory disease
• Pulmonary hypertension Group 5 of Dana Point, of unclear or multifactorial mechanism
• Hypersensitivity to HEXABRIX, to iodinated contrast product or one of its components
• Obvious thyrotoxicosis
• Protected major persons
• Pregnant or breastfeeding women
• Persons deprived of liberty
• Persons in emergency situations.
• No consent signed or approoved
• Persons no affiliated to national social security