title: Transvenous liver biopsy via the femoral vein.
abstract: OBJECTIVE
  To study the safety, effectiveness and diagnostic value of transvenous forceps biopsy of the liver in 54 patients with coagulopathy, gross ascites or morbid obesity and suspected liver disease in whom percutaneous liver biopsy was contraindicated.
  
  
  METHODS
  Forceps biopsy of the liver via the femoral vein was attempted in 54 adult patients with advanced liver disease of unknown aetiology who had coagulation disorders (41 cases), gross ascites (11 cases) or morbid obesity (two cases). In each patient two to six biopsies (average four) were taken using a radial jaw forceps inserted via the right or left femoral vein.
  
  
  RESULTS
  The procedure was successful in 53 cases. Hepatic vein catheterization failed in one patient. Adequate liver tissue for diagnosis was obtained in 84% of cases. One patient developed delayed haemorrhage at 12 h from a capsular leak that was undetected during the biopsy procedure. This patient required blood transfusions and laparotomy to control bleeding. There were no deaths in the 53 patients studied. Transient minor chest and shoulder pain was encountered during sheath insertion into a hepatic vein in 23 patients. Three patients developed a femoral vein haematoma, which resolved with conservative treatment.
  
  
  CONCLUSIONS
  Transvenous liver biopsy via the femoral vein is another safe, effective, simple alternative technique of biopsy when the percutaneous route is contraindicated.
authors.affiliation: Department of Radiology, St James's Hospital, Dublin 8, Ireland. fkhosa@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Khosa
authors.forename: J G
authors.initials: JG
authors.lastname: McNulty
authors.forename: N
authors.initials: N
authors.lastname: Hickey
authors.forename: P
authors.initials: P
authors.lastname: O'Brien
authors.forename: A
authors.initials: A
authors.lastname: Tobin
authors.forename: N
authors.initials: N
authors.lastname: Noonan
authors.forename: B
authors.initials: B
authors.lastname: Ryan
authors.forename: P W N
authors.initials: PW
authors.lastname: Keeling
authors.forename: D P
authors.initials: DP
authors.lastname: Kelleher
authors.forename: G S A
authors.initials: GS
authors.lastname: McDonald
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical; D001794:Blood Pressure; D002406:Catheterization, Peripheral; D005260:Female; D005268:Femoral Vein; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000293:injuries / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010690:Phlebography; D013525:Surgical Instruments