Transjugular Patent Foramen Ovale Closure in the Setting of Inferior Vena Cava Interruption.

BACKGROUND: Percutaneous patent foramen ovale (PFO) closure typically uses femoral venous access. Congenital or acquired inferior vena cava (IVC) interruption precludes this route and presents a significant technical challenge. CASE SUMMARY: A 54-year-old man was referred for PFO closure following cryptogenic embolic stroke. Femoral access failed; intraprocedural venography confirmed IVC interruption. The case was reattempted via the right internal jugular vein. A 30-mm PFO closure device was deployed using a preshaped transcatheter aortic valve replacement guidewire anchored in the left ventricle for support. REVIEW SUMMARY: Fifteen published cases detail PFO closure via transjugular, transhepatic, and upper-limb access. The transjugular approach requires specific strategies to overcome the unfavorable crossing angle, including preformed or steerable catheters and distal wire anchoring in the pulmonary veins, left atrium, or left ventricle. TAKE-HOME MESSAGES: Congenital or acquired IVC interruption necessitates alternative access strategies for percutaneous PFO closure. While technically demanding, transjugular and transhepatic routes are feasible alternatives.