Which access is indicated only when the thoracic veins and the infrarenal inferior vena cava are occluded?

Transhepatic access is a procedure that is specifically indicated when conventional access routes through the thoracic veins and the infrarenal inferior vena cava are obstructed. This type of access involves puncturing the liver to reach the hepatic veins and the inferior vena cava directly. It is particularly useful in scenarios where other vascular access is not feasible due to occlusions, which may lead to complications or failed attempts at standard access routes.

By using transhepatic access, clinicians can bypass the obstructed pathways, allowing for necessary interventions, such as placing stents or performing embolization procedures, that would otherwise be impossible using traditional access points. The anatomical considerations of the liver and its proximity to the inferior vena cava make this approach viable and can be lifesaving in specific clinical situations.

Other options, such as subclavian or upper extremity veins, while commonly used for vascular access, are not indicated in cases where the inferior vena cava is obstructed, as these accesses do not provide a route to the IVC. On the other hand, translumbar access is used more commonly for different indications and is not the primary choice when both thoracic veins and infrarenal IVC are occluded. Thus, when standard access is unavailable due to occlusion,