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

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Nonvalvular atrial fibrillation with inferior vena cava interruption (n=1). Intervention: Transhepatic venous access for LAAO. Primary outcome: Procedural success and complications.

Q: What does this research mean for the field?

Transhepatic access for left atrial appendage closure is safe and effective for patients with inferior vena cava interruption and complex venous anatomy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Pablo D. D Liva; Guillermo Eisele; M Aguero; Esteban Villegas; Gastón Pozzi; Pedro Zambrano-Rodas; G. Ríos; Adolfo G. López-Campanher; Matias J Arévalo; Jorge Baccaro

doi:10.1016/j.jaccas.2025.106614

January 1, 2026JACC Case ReportsOpen Access

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

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Key result

Transhepatic access enables safe LAAO in patients with IVC interruption and complex venous anatomy.

n=1

Figures

Graphical abstract published by JACC Case Reports — Graphical abstract · Published by JACC Case Reports · CC BY

Why the study?

Does transhepatic venous access allow successful left atrial appendage occlusion in a patient with inferior vena cava interruption?

Key Points

To describe the feasibility and procedural success of utilizing a transhepatic venous approach for left atrial appendage closure when femoral venous access is anatomically obstructed.
Evaluated a 78-year-old female with nonvalvular atrial fibrillation and high bleeding risk requiring left atrial appendage occlusion.
Converted an aborted femoral access procedure to a staged transhepatic venous access approach following the intraprocedural discovery of congenital inferior vena cava interruption.
Left atrial appendage occlusion was successfully deployed via the transhepatic venous route without intraprocedural or postprocedural complications.
Demonstrated that alternative hepatic venous access provides a safe and effective pathway for structural cardiac interventions in patients with interrupted systemic venous anatomy.

Study Design

Type

Case Report (n=1)

Structured PICO

Does transhepatic venous access allow successful left atrial appendage occlusion in a patient with inferior vena cava interruption?

P

Population

A 78-year-old woman with nonvalvular atrial fibrillation, high bleeding risk, and congenital inferior vena cava interruption referred for left atrial appendage occlusion.

I

Intervention

Left atrial appendage occlusion (LAAO) via transhepatic venous access.

O

Outcome

Procedural success and complications.

Transhepatic access provides a feasible and safe alternative route for left atrial appendage occlusion in patients with complex venous anatomy such as inferior vena cava interruption.

Implication

May offer an alternative LAAO access route in IVC interruption; hypothesis-generating and requires prospective validation.

Abstract

BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: This case highlights the feasibility of transhepatic access for structural heart interventions in patients with complex venous anatomy. TAKE-HOME MESSAGES: 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.

Discussion

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Cite This Study

Liva et al. (2026) conducted a case report in Nonvalvular atrial fibrillation with inferior vena cava interruption (n=1). Transhepatic venous access for LAAO was evaluated on Procedural success and complications. Transhepatic venous access was successfully used to complete left atrial appendage occlusion without complications in a patient with congenital inferior vena cava interruption.

synapsesocial.com/papers/69731005c8125b09b0d1fb4a https://doi.org/10.1016/j.jaccas.2025.106614

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

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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