Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension

Evidence on the safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension shows the potential for serious but well-recognised complications. In relation to efficacy:

• For patients for whom pulmonary endarterectomy is considered to be unsuitable (because of comorbidities or the distribution of their arterial disease), evidence on efficacy is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.

• For patients for whom pulmonary endarterectomy is considered to be suitable, evidence on efficacy is inadequate, especially in the long term. Therefore, for these patients, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Clinicians wishing to offer balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension to patients for whom pulmonary endarterectomy would be suitable should:

• Inform the clinical governance leads in their NHS trusts.

• Ensure that patients understand the uncertainty about the procedure's efficacy, especially in the long term, and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.

• Audit and review clinical outcomes of all patients having balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (see section 7.1).

Patient selection and treatment should only be done in units specialising in the management of chronic thromboembolic pulmonary hypertension and which have timely access to services that are able to deal with any complications.

NICE encourages further research into balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. Details of patient selection, all complications, and subsequent treatments and interventions for pulmonary hypertension should be collected. Reports should include quality-of-life outcomes, long-term efficacy outcomes and survival. NICE may update the guidance on publication of further evidence.