Transfemoral approach through inferior vena cava filters for complex cardiac interventions: expanding the limits

Performing complex cardiac interventions that need atrial septal crossing in patients with a previously implanted inferior vena cava filter (ICVF) has proven difficult. Accordingly, some authors have chosen accesses different from the traditional femoral vein approach. Here, we report two cases of complex cardiac procedures performed via the femoral vein and through an IVCF. In the first case, a percutaneous mitral valvuloplasty was performed in an elderly woman after crossing the IVCF with a large sheath. In the second case, simultaneous left atrial appendage and patent foramen ovale closures were performed. In both experiences, the key step was to secure the access by positioning a long sheath with its tip above the IVCF and not removing it until the procedure had finished. These cases further support the use of traditional femoral vein access in patients with IVCF and confirm the possibility of performing complex cardiac interventions in these scenarios.