Background-Balloon pulmonary angioplasty (BPA) is an effective and safe method of treating patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Currently, femoral and jugular vein accesses are the most frequently used for BPA. Authors all over the world report different numbers of access side complications, mostly exceeding 0.4%. We suggest new alternative access for BPA procedures-antecubital vein access (AVA) that is safe and easy. Methods-In 2015-2017 period we performed 64 BPA in 19 patients with inoperable CTEPH. We performed BPA via AVA using standard radial access kit and in case of unsuccessful AVA we switched to femoral vein access (FVA). All procedures were successful with no serious complications and patients demonstrated clinical and hemodynamic improvement. Results-Fifty-six from 64 procedures (87.5%) were performed via AVA, 8-via femoral access (12.5%). There were no severe complications via AVA, local extravasates were managed with bandage compression. Conclusion-Performing BPA via AVA in patients with CTEPH is a new alternative approach that is safe and easy.

Introduction. Chronic thromboembolic pulmonary hypertension is a precapillary form of pulmonary hypertension that develops due to thrombotic mass obstruction of the pulmonary arteries. Balloon pulmonary angioplasty (BPA) is a new, alternative treatment method for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), which demonstrated good hemodynamic and clinical effects. In this article we studied the long-term outcomes results after BPA. Material and methods. The study included 22 patients with inoperable CTEPH who were treated by BPA 6 (5; 8) interventions per patient. The results of the procedure were evaluated 2 months and 18 (12; 18) months after the last BPA. Results. A significant decrease in all important hemodynamic parameters was noted. There no difference between the date immediately after the operation and the long term period. However, the division of patients into groups with and without disease progression allow us to identify factors affecting the effectiveness of BPA (weight, the number of BPA procedures per patient, the total number of treated segmental arteries, the presence of coronary heart disease and chronic obstructive pulmonary disease, not the appointment of a concomitant pathogenetic pulmonary arterial hypertension (PAH) therapy. Conclusion. BPA is an effective method of treating patients with inoperable CTEPH, which demonstrates a good, sustainable long-term result. Patients with classical type 4 pulmonary hypertension receiving PAH-specific therapy are best responders to BPA.

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