Transhepatic Access for Transcatheter ASD Closure in Patients With Interrupted IVC

Atrial septal defect (ASD) is typically managed with percutaneous transcatheter closure via femoral venous access. In patients with interrupted inferior vena cava (IVC), however, conventional access is not feasible. Although the transhepatic approach has been described, it is less frequently utilized. We report 2 patients with secundum ASD and interrupted IVC who underwent successful device closure through transhepatic venous access. Complete closure was obtained in both cases. These cases highlight the feasibility of transhepatic access for ASD closure when femoral access is not possible. Ultrasound guidance and coil embolization of the hepatic tract appear to be important strategies for reducing complications, particularly hemorrhage. One of our patients developed hemoperitoneum requiring emergent laparotomy, whereas the second patient had an uneventful recovery. Transhepatic access provides a valuable alternative route for percutaneous ASD closure in patients with interrupted IVC, and it can expand therapeutic options for structurally complex cases.