Key result
Alternative transseptal access approaches prove safe and feasible for patients with IVC obstruction.
Why the study?
Standard transseptal access via the femoral vein and IVC is impossible in patients with IVC obstruction, necessitating alternative approaches.
Alternative transseptal access routes, such as transhepatic or superior approaches, provide feasible and safe options for electrophysiology procedures in patients with IVC obstruction.
Transseptal puncture via a femoral vein and inferior vena cava (IVC) is a commonly performed procedure in multiple electrophysiology studies that require access to the left atrium or left ventricle. However, the standard approach is impossible in certain anatomies with IVC obstruction, such as congenital IVC interruption with azygos continuation and acquired obstruction. Here, we describe a step-by-step approach to alternative methods for transseptal access, including the transhepatic approach and superior approach from either the internal jugular vein or axillary vein. With careful review of multi-modal imaging and multidisciplinary preprocedural planning, these methods are feasible and safe alternatives to transseptal access.
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Limpitikul et al. (2025) conducted a review in Inferior vena cava (IVC) obstruction requiring transseptal access. Alternative transseptal access approaches (transhepatic, internal jugular, or axillary vein) was evaluated. Alternative methods for transseptal access, including transhepatic and superior approaches, are feasible and safe alternatives for patients with inferior vena cava obstruction.
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