Transvenous Liver Biopsy in Patients with Cirrhosis with Use of the Femoral Venous Approach and a Flexible Forceps

Abstract

Jose I. Bilbao, MD Jesus Sola, MD Alfonso Iglesias, MD Felix Contreras, MD Bruno Sangro, MD Jesus M. Longo, MD Jesus J. Vazquez, MD P m c u T A N E o u s liver biopsy is often essential in the definitive diagnosis of liver diseases. However, parenchymal liver diseases are sometimes associated with coagulation disorders or ascites. In such cases, the conventional percutaneous approach is contraindicated due to the high risk of hemorrhage, which could lead to death (1). When both thrombocytopenia and prolonged prothrombin time are present, different approaches to the classic technique have been suggested, like plugging of the needle tract ( 2 4 ) or transjugular liver biopsy, for which extensive experience (5) and good histologic results have been reported (5-7). These techniques, however, are not without risk of bleeding. For this reason, a new transvenous approach consisting of the introduction of forceps through femoral vein puncture has been reported for patients with and without cirrhosis (8,9). We have used this approach in the performance of biopsies in 30 consecutive patients with known or suspected cirrhosis.