Two Cases of Major Hemorrhage Secondary to Transjugular Liver Biopsy

ABSTRACT

Transjugular liver biopsy is an essential procedure in the armamentarium of the interventional radiologist for patients who otherwise are unable to undergo percutaneous liver biopsy. Multiple conditions exist that necessitate the transjugular approach for biopsy, including acquired coagulopathy, congenital blood disorders, or requirement for measurements of hepatic venous and/or wedged hepatic vein pressures. The safety and efficacy of transjugular liver biopsy is well established, with many studies citing extremely low rates of complication with high rates of technical success. Nonetheless, transjugular liver biopsy is not without complications. The most often reported complication is asymptomatic capsular perforation; however occasionally, major hemorrhagic complications and even death have been reported. We describe two major hemorrhagic complications that manifested several days after the procedure and required emergent intervention.

Liver - biopsy - complication - transjugular

REFERENCES

• 1 Ahmad A, Hasan F, Abdeen S et al.. Transjugular liver biopsy in patients with end- stage renal disease.  J Vasc Interv Radiol. 2004;  15 257-260
• 2 Dawson M A, McCarthy P H, Walsh M E et al.. Transjugular liver biopsy is a safe and effective intervention to guide management for patients with a congenital bleeding disorder infected with hepatitis C.  Intern Med J. 2005;  35 556-559
• 3 Bull H JM, Gilmore I T, Bradley R D et al.. Experience with transjugular liver biopsy.  Gut. 1983;  24 1057-1060
• 4 Choh J, Dolmatch B, Safadi R et al.. Transjugular core liver biopsy with a 19-gauge spring-loaded cutting needle.  Cardiovasc Intervent Radiol. 1998;  21 88-90
• 5 Corr P, Beningfield S J, Davey N. Transjugular liver biopsy: a review of 200 biopsies.  Clin Radiol. 1992;  45 238-239
• 6 Gamble P, Colapinto R F, Stronell R D et al.. Transjugular liver biopsy: a review of 461 biopsies.  Radiology. 1985;  157 589-593
• 7 Gorriz E, Reyes R, Lobrano M B et al.. Transjugular liver biopsy: a review of 77 biopsies using a spring-propelled cutting needle (biopsy gun).  Cardiovasc Intervent Radiol. 1996;  19 442-445
• 8 McAfee J H, Keeffe E B, Lee R G et al.. Transjugular liver biopsy.  Hepatology. 1992;  15 726-732
• 9 Smith T P, Presson T L, Heneghan M A et al.. Transjugular biopsy of the liver in pediatric and adult patients using an 18-gauge automated core biopsy needle: a retrospective review of 410 consecutive procedures.  AJR Am J Roentgenol. 2003;  180 167-172
• 10 Banares R, Alonso S, Catalina M V et al.. Randomized controlled trial of aspiration needle versus automated biopsy device for transjugular liver biopsy.  J Vasc Interv Radiol. 2001;  12 583-587
• 11 Colapinto R F. Transjugular biopsy of the liver.  Clin Gastroenterol. 1985;  14 451-467
• 12 Kardache M, Soyer P, Boudiaf M et al.. Transjugular liver biopsy with an automated device.  Radiology. 1997;  204 369-372
• 13 Roche C J, Lee W K, Duddalwar V A et al.. Intrahepatic pseudoaneurysm complicating transjugular biopsy of the liver.  AJR Am J Roentgenol. 2001;  177 819-821
• 14 Chau T N, Tong S W, Li T M et al.. Transjugular liver biopsy with an automated trucut-type needle: comparative study with percutaneous liver biopsy.  Eur J Gastroenterol Hepatol. 2002;  14 19-24
• 15 Lebrec D, Goldfarb G, Degott C et al.. Transvenous liver biopsy: an experience based on 1000 hepatic tissue samplings with this procedure.  Gastroenterology. 1982;  83 338-340
• 16 Little A F, Zajko A B, Orons P D. Transjugular liver biopsy: a prospective study in 43 patients with the Quick-Core biopsy needle.  J Vasc Interv Radiol. 1996;  7 127-131