Left Atrial Appendage Closure Via Transhepatic Access in a Patient With Congenitally Interrupted Inferior Vena Cava

Left atrial appendage occlusion (LAAO) is indicated for patients with nonvalvular atrial fibrillation at risk of thromboembolic stroke and intolerant to long-term anticoagulation. Standard procedural access for LAAO is from the transfemoral approach. In certain circumstances where this is prohibitive, options are limited.

A patient with atrial fibrillation underwent unsuccessful LAAO due to interrupted inferior vena cava (IVC). She was referred for consideration of LAAO via an alternative access. Using a transhepatic approach, she underwent successful occlusion with a 31-mm Watchman FLX Pro device.

Although rare, transfemoral venous approach can be prohibitive for several reasons, including congenitally absent IVC, occluded IVC filter, or extrinsic compression. This case highlights the preprocedural planning, technical approach, and postprocedural considerations for successful LAAO using a transhepatic approach.

Alternate access via a transhepatic approach can be a viable alternative for LAAO when the standard femoral venous approach is prohibitive.