Preprocedural Planning

Obtain informed consent. Confirm that there is no contrast allergy and that the platelet count is higher than 50,000/μL. Patient should have nothing by mouth for 4-6 hours prior to the procedure.

Equipment

A commonly used biopsy kit is manufactured by Cook Medical (Bloomington, IN). The kit contains the following materials, which can be assembled if the kit is unavailable:

Long (49 cm) sheath, 7 French (see the first image below)
Angled metal sheath stiffener (see the second image below)
Straight catheter, 5 French
Cutting biopsy needle, 60 cm (see the third image below)
Multipurpose catheter, 5 French
Guide wire

Transjugular liver biopsy. 7-French sheath (outer blue) with inner straight catheter (black).

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Transjugular liver biopsy. Sheath with metal stiffener. Note metal guide at proximal end.

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Transjugular liver biopsy. Biopsy needle.

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Other equipment needed includes the following:

Ultrasound machine with linear-array probe
Fluoroscopy
Skin disinfectant (eg, chlorhexidine, povidone-iodine solution)
Heparinized saline (1000 U heparin in 1000 mL of 0.9% NaCl)
Basic angiography kit, including puncture needle
Sheath, 5 French
Cobra-2 catheter
Hydrophilic-coated guide wire (eg, from Terumo, Somerset, NJ)
1-cm floppy-tip Amplatz guide wires

Anesthesia

In adults, local anesthesia (eg, lidocaine 1% 10 mL) is required for the jugular puncture site on the neck. (For more information, see Local Anesthetic Agents, Infiltrative Administration.) In children, general anesthesia is usually required for this procedure.

Positioning

Position the patient supine with the patient’s head turned away from the jugular puncture site.

Technique

Kaufman CS, Cretcher MR. Transjugular Liver Biopsy. Tech Vasc Interv Radiol. 2021 Dec. 24 (4):100795. [QxMD MEDLINE Link].
Ble M, Procopet B, Miquel R, Hernandez-Gea V, García-Pagán JC. Transjugular liver biopsy. Clin Liver Dis. 2014 Nov. 18 (4):767-78. [QxMD MEDLINE Link].
Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001 Feb 15. 344 (7):495-500. [QxMD MEDLINE Link].
Cholongitas E, Quaglia A, Samonakis D, Mela M, Patch D, Dhillon AP, et al. Transjugular liver biopsy in patients with diffuse liver disease: comparison of three cores with one or two cores for accurate histological interpretation. Liver Int. 2007 Jun. 27 (5):646-53. [QxMD MEDLINE Link].
Kalambokis G, Manousou P, Vibhakorn S, Marelli L, Cholongitas E, Senzolo M, et al. Transjugular liver biopsy--indications, adequacy, quality of specimens, and complications--a systematic review. J Hepatol. 2007 Aug. 47 (2):284-94. [QxMD MEDLINE Link].
Miraglia R, Maruzzelli L, Minervini MI, Volpes R, Vizzini G, Gruttadauria S, et al. Transjugular liver biopsy in liver transplant patients using an 18-gauge automated core biopsy needle. Eur J Radiol. 2011 Dec. 80 (3):e269-72. [QxMD MEDLINE Link].
Behrens G, Ferral H, Giusto D, Patel J, Van Thiel DH. Transjugular liver biopsy: comparison of sample adequacy with the use of two automated needle systems. J Vasc Interv Radiol. 2011 Mar. 22 (3):341-5. [QxMD MEDLINE Link].
Dinkel HP, Wittchen K, Hoppe H, Dufour JF, Zimmermann A, Triller J. [Transjugular liver core biopsy: indications, results, and complications]. Rofo. 2003 Aug. 175 (8):1112-9. [QxMD MEDLINE Link].
Miraglia R, Maruzzelli L, Spada M, Riva S, Luca A, Gridelli B. Transjugular liver biopsy in pediatric patients with left split liver transplantation and severe coagulation impairment. Pediatr Transplant. 2012 Feb. 16 (1):58-62. [QxMD MEDLINE Link].
Lee EW, Sue MJ, Saab S, DiNorcia J 3rd, McWilliams JP, Kaldas F, et al. Accuracy and Safety of 1,055 Transjugular Liver Biopsies in Postliver Transplant Patients. Clin Transl Gastroenterol. 2021 May 21. 12 (5):e00355. [QxMD MEDLINE Link]. [Full Text].
Srivastava A, Prasad D, Panda I, Yadav R, Jain M, Sarma MS, et al. Transjugular Versus Percutaneous Liver Biopsy in Children: Indication, Success, Yield, and Complications. J Pediatr Gastroenterol Nutr. 2020 Apr. 70 (4):417-422. [QxMD MEDLINE Link].
Lal BB, Sood V, Rastogi A, Mukund A, Khanna R, Sharma MK, et al. Safety, Feasibility, Yield, Diagnostic and Prognostic Implications of Transjugular Liver Biopsy in Children and Adolescents. J Pediatr Gastroenterol Nutr. 2021 Nov 1. 73 (5):e109-e114. [QxMD MEDLINE Link].
Sue MJ, Lee EW, Saab S, McWilliams JP, Durazo F, El-Kabany M, et al. Transjugular Liver Biopsy: Safe Even in Patients With Severe Coagulopathies and Multiple Biopsies. Clin Transl Gastroenterol. 2019 Jul. 10 (7):e00063. [QxMD MEDLINE Link].
Kaufman C, Aryafar H, Minocha J, Kinney T. Transjugular liver biopsy after transjugular intrahepatic portosystemic shunt (TIPS) or direct intrahepatic portocaval shunt (DIPS): Is it feasible, effective, and safe?. Diagn Interv Imaging. 2018 May. 99 (5):331-335. [QxMD MEDLINE Link].
Yavuz K, Geyik S, Barton RE, Petersen B, Lakin P, Keller FS, et al. Transjugular liver biopsy via the left internal jugular vein. J Vasc Interv Radiol. 2007 Feb. 18 (2):237-41. [QxMD MEDLINE Link].
Turba UC, Uflacker R, Hannegan C, Selby JB. Anatomic relationship of the internal jugular vein and the common carotid artery applied to percutaneous transjugular procedures. Cardiovasc Intervent Radiol. 2005 May-Jun. 28 (3):303-6. [QxMD MEDLINE Link].
Kessel D, Robertson I. Interventional Radiology: A Survival Guide. 4th ed. Philadelphia: Elsevier; 2017.
Hari A, Nair HK, De Gottardi A, Baumgartner I, Dufour JF, Berzigotti A. Diagnostic hepatic haemodynamic techniques: safety and radiation exposure. Liver Int. 2017 Jan. 37 (1):148-154. [QxMD MEDLINE Link].
Ahmed O, Ward TJ, Lungren MP, Abdelrazek Mohammed MA, Hofmann LV, Sze DY, et al. Assessing the Risk of Hemorrhagic Complication following Transjugular Liver Biopsy in Bone Marrow Transplantation Recipients. J Vasc Interv Radiol. 2016 Apr. 27 (4):551-7. [QxMD MEDLINE Link].
Sawatzki M, Heim M. [Delayed upper abdominal pain and tarry stool after transjugular liver biopsy. A 24-old man with hemophilia]. Praxis (Bern 1994). 2007 Mar 28. 96 (13):509-11. [QxMD MEDLINE Link].
Kruse-Jarres R, Leissinger CA. Haemobilia after transjugular liver biopsy in a patient with severe haemophilia. Haemophilia. 2005 Nov. 11 (6):642-3. [QxMD MEDLINE Link].
Park HS, Lee SH, Kim YI, Lee JS, Lim MK, Park JW, et al. Postbiopsy arterioportal fistula in patients with hepatocellular carcinoma: clinical significance in transarterial chemoembolization. AJR Am J Roentgenol. 2006 Feb. 186 (2):556-61. [QxMD MEDLINE Link].
Fricker Z, Levy E, Kleiner D, Taylor JG 6th, Koh C, Holland SM, et al. Case series: biliary leak after transjugular liver biopsy. Am J Gastroenterol. 2013 Jan. 108 (1):145-7. [QxMD MEDLINE Link].
Roche CJ, Lee WK, Duddalwar VA, Nicolaou S, Munk PL, Morris DC. Intrahepatic pseudoaneurysm complicating transjugular biopsy of the liver. AJR Am J Roentgenol. 2001 Oct. 177 (4):819-21. [QxMD MEDLINE Link].
Dohan A, Guerrache Y, Dautry R, Boudiaf M, Ledref O, Sirol M, et al. Major complications due to transjugular liver biopsy: Incidence, management and outcome. Diagn Interv Imaging. 2015 Jun. 96 (6):571-7. [QxMD MEDLINE Link].
Lavian JD, Thornton LM, Zybulewski A, Kim E, Nowakowski SF, Ranade M, et al. Safety of percutaneous versus transjugular liver biopsy: A propensity score matched analysis. Eur J Radiol. 2020 Dec. 133:109399. [QxMD MEDLINE Link].

Media Gallery

Transjugular liver biopsy. Ultrasound-guided right internal jugular puncture.
Transjugular liver biopsy. Prebiopsy right hepatic venography.
Transjugular liver biopsy. 7-French sheath with metal guide after removal of Amplatz wire.
Transjugular liver biopsy. Biopsy needle advanced through sheath after guide is turned anteriorly.
Transjugular liver biopsy. 7-French sheath (outer blue) with inner straight catheter (black).
Transjugular liver biopsy. Biopsy needle.
Transjugular liver biopsy. Sheath with metal stiffener. Note metal guide at proximal end.
Transjugular liver biopsy. Angle metal guide upward as shown, and then fire gun.

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Transjugular Liver Biopsy Periprocedural Care

Preprocedural Planning

Equipment

Patient Preparation

Anesthesia

Positioning

Transjugular Liver Biopsy Periprocedural Care

Preprocedural Planning

Equipment

Patient Preparation

Anesthesia

Positioning

References

Tables

Contributor Information and Disclosures

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