The Safety and Efficacy of Transfemoral Transcaval Liver Biopsy: An Update on Our Experience of 552 Cases

To quantify the experiences of our department in the use of the transfemoral transcaval (TFTC) approach to image-guided liver biopsy.

 

Materials and Methods:

This paper is a continuation of our institution’s previously published retrospective study on transvenous liver biopsies, of which 286 were performed via TFTC approach. That study demonstrated TFTC to be associated with lower rates of major complications and lower fluoroscopy times compared to transjugular liver biopsy while maintaining comparable technical and histopathologic success {1}. Between January 2019 and September 2022, we performed 266 TFTC liver biopsies in 252 patients; in addition to the 286 TFTC biopsies performed between December 2010 and December 2018. This is a follow-up study to present the compilation of outcomes and complications of over 550 TFTC liver biopsies. Procedural complications were classified according to the Society of Interventional Radiology guidelines.

Results:

552 TFTC biopsies (40.2% women; mean age 50.9 ± 16.7 years) were evaluated in terms of technical success, histopathological success, portal pressure measurements and complication rates. Technical success was achieved in 99.46% of cases (549/552). Histopathological success was attained in 97.10% of cases (535/551). One patient who underwent liver biopsy for organ donation did not have pathology records in our system. Portal pressure measurements were obtained when requested, in 435 cases. Major complications occurred in 1.45% of cases (8/552). Three of these cases (0.54%) were complicated by persistent access site bleeding and were successfully managed without need for significant reintervention. Three cases (0.54%) were complicated by sepsis that required IV antibiotics in 2 cases and medical management for septic shock in 1 case. Two cases (0.36%) were complicated by biopsy related bleeding that necessitated angiogram and embolization which resolved the bleeds. Of these, one involved a patient with an ECMO catheter in the IVC awaiting heart-lung transplantation. The other was a liver transplant patient with a Roux-en-Y and 2 prior uncomplicated TFTC biopsies. This time, the biopsy was performed too close to the undersurface of the liver and not the intrahepatic portion of the IVC. This resulted in a GI bleed from the transgressed bowel and was treated successfully by embolization. These cases will be further elaborated on in manuscript.

Conclusion:

The TFTC approach is a safe and effective method for liver biopsy. This large retrospective study demonstrates the advantages and possible pitfalls to avoid in this procedure.