Transcatheter liver biopsy is an elegant method of performing liver biopsy in patients with massive ascites and/or prolonged prothrombin time, both common occurrences in liver disease. The technique can also be extended to diagnose and angiographically treat Budd-Chiari syndrome when this abnormality is encountered during a transjugular liver biopsy.
Indications include:
- Presence of massive ascites
- Presence of massive obesity
- Severe coagulopathy
- Failed percutaneous biopsy
- Suspected vascular tumor or peliosis hepatitis
- Need for ancillary vascular procedures (eg, TIPS, venography)
There are no major contraindications. Thrombosis of the internal jugular vein is a relative contraindication. Uncooperative and pediatric patients may require anesthesia. The angulation of the right hepatic vein with the inferior vena cava (IVC) might be acute and hinder access with the metallic cannula.