Transjugular Access for Left Atrial Appendage Closure

Percutaneous left atrial appendage closure (LAAC) is an established therapy for stroke prevention in atrial fibrillation patients unable to tolerate long-term oral anticoagulation. Transfemoral access is standard, but may be precluded by chronic venous occlusion, severe iliocaval tortuosity, or other anatomical barriers. We describe 2 patients with paroxysmal atrial fibrillation, elevated thromboembolic risk, and absolute contraindications to anticoagulation who were unsuitable for transfemoral LAAC due to prohibitive femoral venous anatomy. In both cases, right internal jugular venous access was obtained, and trans-septal puncture was performed using a steerable sheath and adjunctive wire strategies to optimize trajectory. A Watchman FLX Pro device was successfully implanted in each patient without periprocedural complications, and follow-up imaging confirmed stable position and complete appendage seal. The transjugular approach is a technically feasible alternative in cases where transfemoral access cannot be achieved. In anatomically challenging cases, transjugular LAAC can achieve successful outcomes with appropriate technique and equipment.