Key result
Transhepatic venous access enables successful Watchman implantation despite occluded femoral veins.
Why the study?
Conventional femoral vein access for Watchman device implantation may be limited by tortuosity and venous occlusion, and subclavian vein access poses catheter manipulation challenges making transhepatic access a potential alternative.
Case Report (n=1)
No
Transhepatic vascular access may serve as a favorable alternative for Watchman device implantation when conventional femoral access is limited.
Transhepatic access may enable Watchman implantation when femoral routes are occluded; hypothesis-generating and requires prospective validation before adoption.
Conventional access through femoral veins may be limited due to tortuosity and venous occlusion secondary to venous thrombosis or congenital anomalies. Another alternative is subclavian veins, but the difficulty in catheter manipulation and stability makes it less favorable in comparison to the transhepatic access for the delivery of the Watchman device.
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Morcos et al. (2018) conducted a case report in Non-valvular atrial fibrillation with occluded femoral venous system (n=1). Transhepatic vascular access for Watchman device implantation was evaluated on Successful device deployment and absence of complications. Percutaneous transhepatic venous access was successfully utilized to implant a Watchman left atrial appendage closure device in a patient with an occluded femoral venous system.
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