Chronic thromboembolic pulmonary hypertension results from repeated or unresolved emboli in the pulmonary circulation, and occurs in 3–4% of patients suffering acute pulmonary embolism. Pulmonary thromboendarterectomy is an endarterectomy of the entire pulmonary vascular tree, and is the preferred treatment for chronic thromboembolic pulmonary ­hypertension. The most common presenting symptom of chronic thromboembolic pulmonary hypertension is exertional dyspnea. The diagnosis is confirmed with echocardiography, right-sided cardiac catheterization, and pulmonary angiogram. Patients with chronic thromboembolic pulmonary hypertension, when left untreated, develop a small-vessel vasculopathy that mimics idiopathic pulmonary hypertension. Monitoring includes femoral and radial arterial ­pressures, processed EEG, pulmonary artery pressures, and transesophageal echocardiography. Anesthetic induction and maintenance are tailored to hemodynamic stability, right ventricular coronary perfusion pressure, and right ventricular support. Factors that lead to increased pulmonary vascular resistance, such as light anesthesia, acidosis, and hypoxemia, should be avoided. Pulmonary vasodilators such as nitric oxide and milrinone are generally ineffective in chronic thromboembolic pulmonary hypertension, but should be available for management of patients with small-vessel vasculopathy.