Percutaneous transhepatic approach for cryoballoon pulmonary vein isolation in a patient with persistent atrial fibrillation and interruption of the inferior vena cava

Successful left atrial appendage closure using a percutaneous hepatic venous approach

“…As LAAC becomes more common, patients with obstructions in the IVC are being encountered. There have been previous reports of electrophysiological procedures conducted through nontraditional vascular access 3, 4, 5, 6, 7, 8. Here we describe, to our knowledge, the first case of a transhepatic access and successful deployment of a Watchman device without leaving an indwelling catheter at the access site.…”

Direct hepatic vein puncture and transseptal access for atrial flutter and fibrillation ablation in a patient with prior ligation of the inferior vena cava

“…In this case, support from interventional radiology was critical for initial access of the hepatic vein. Although transhepatic access for left heart procedures has been described previously, 5 , 8 , 9 , 10 , 11 , 12 several technical challenges and a higher risk of complications may present using these reported methods, and may inhibit the adoption of this technique.…”

Percutaneous transhepatic venous access for atrial tachyarrhythmia ablation in patients with single ventricle and interrupted inferior vena cava

“…Congenital absence or stenosis of the IVC has an incidence of approximately 0.15% in the general population 10 and is characterized by the presence of collateral venous flow from the lower extremities through the azygos and hemiazygos systems to the SVC. In patients with such anomalies undergoing catheter ablation, either a superior central venous or retrograde aortic approach can present challenges for catheter manipulation and stability 2, 3, 4, 5, 6, 7…”

“…Patients with congenital heart disease (CHD) who have undergone corrective and/or palliative surgery are at risk of developing different types of tachyarrhythmias, and their invasive management can represent a challenge to the electrophysiologist because of their complex anatomy, extensive surgical reconstructions, and use of intracardiac and extracardiac baffles and shunts, which limit conventional access to the cardiac chambers 1 . In cases in which there are interruptions or anomalies of the inferior vena cava (IVC), a superior approach or a retrograde aortic arterial access to gain entry into the cardiac chambers may be used, but catheter stability and manipulation can prove very difficult in comparison with a standard femoral venous approach 2, 3, 4, 5, 6, 7…”

“…Case studies of patients undergoing various cardiac interventions have reported complication rates of less than 5% using this approach 8, 9. Although most cases have been reported in the pediatric population, there is some published data in adult patients 1, 2, 3…”