# Transhepatic Access for Left Atrial Appendage Closure in a Patient With Inferior Vena Cava Interruption

## TL;DR

A patient with a blocked inferior vena cava successfully underwent left atrial appendage closure using a transhepatic approach.

## Contribution

Demonstrates the feasibility and safety of transhepatic access for LAAO in patients with complex venous anatomy.

## Key findings

- Transhepatic access successfully enabled LAAO in a patient with congenital inferior vena cava interruption.
- The procedure was completed without complications, highlighting the viability of this alternative access route.
- Preprocedural imaging and flexible access strategies are crucial for such complex cases.

## Abstract

Left atrial appendage occlusion (LAAO) is an alternative stroke-prevention strategy in patients with nonvalvular atrial fibrillation who have contraindications to oral anticoagulation. Femoral venous access is the standard approach.

We report a 78-year-old woman with nonvalvular atrial fibrillation, high bleeding risk due to recurrent falls, and prior traumatic subdural hematoma, referred for LAAO. The initial procedure attempt was aborted after intraprocedural discovery of congenital inferior vena cava interruption, precluding femoral access. In a second stage, the procedure was successfully completed via transhepatic venous access without complications.

This case highlights the feasibility of transhepatic access for structural heart interventions in patients with complex venous anatomy.

Transhepatic access is a safe alternative for LAAO in patients with inferior vena cava interruption. Preprocedural imaging and flexible access strategies are essential in structural interventions for patients with complex venous anatomy.