Percutaneous closure of the PFO through the right internal jugular vein using a non-steerable sheath: A Case Report

Abstract

Paradoxical embolism is a significant cause of cryptogenic stroke (CS) in patients with patent foramen ovale (PFO). Venous embolism is typically found in the lower extremities. When venous access in the lower extremities is blocked, it can impede occlusion of the PFO and increase the risk of CS recurrence. This case report presents an unusual clinical scenario in a 60-year-old woman. The patient was admitted to the hospital for CS accompanied by migraine. The patent foramen ovale (PFO) was confirmed by agitated saline contrast echocardiography (ASCE). During the percutaneous PFO closure procedure, angiography indicated bilateral iliac vein occlusion, making the conventional vascular approach for PFO closure unusable. The right internal jugular vein was accessed using a non-steerable sheath and the Amplatzer PFO occluder (25/18mm) was successfully implanted for the patient. The position of the occluder was confirmed to be firmly fixed in the atrial septum by transthoracic echocardiography (TTE). One week of postoperative follow-up revealed no complications. Active blocking of PFO in CS patients with venous embolism can be beneficial. When the veins in the lower extremities are not accessible, it may be feasible to utilize the internal jugular veins in the upper body. Generally speaking, a non-steerable sheath is suitable for femoral vascular access in most PFO cases. When the femoral vascular approach is not accessible, a non-steerable sheath can be passed through the right internal jugular vein to complete the PFO occlusion procedure.