title: Transjugular liver biopsy via the left internal jugular vein.
abstract: OBJECTIVE
  To retrospectively review the indications and outcomes of transjugular liver biopsy (TJLB) with the left internal jugular vein (IJV) approach.
  
  
  METHODS
  A retrospective review of all TJLBs performed at one institution was performed. From August 1995 to October 2004, 293 liver biopsies were performed. Nineteen of the 293 procedures (6.5%) were performed from the left IJV in 17 patients. There were 11 men and six women aged 36-59 years (mean, 49.3 years). All patients were suspected of having diffuse hepatic parenchymal disease and had contraindications to conventional percutaneous liver biopsy. The stiff metal biopsy cannula was advanced across the mediastinum and through the heart over a stiff guide wire. Biopsy was performed from the right hepatic vein in 15 procedures, the middle hepatic vein in two, and the intrahepatic IVC in two.
  
  
  RESULTS
  The indications for using the left IJV approach were nonusable right IJV in 12 procedures, difficult previous catheterization of the hepatic veins from the right IJV due to distorted hepatic anatomy in six procedures, and the operator's predilection for this approach in one procedure (the patient had previously undergone liver transplantation). All biopsies were successful, with diagnostic tissue obtained in 100% of cases. Two patients had chest pain during the procedure associated with placement of the rigid cannula through the mediastinal veins. One patient had a vaso-vagal episode that necessitated the use of intravenous atropine but subsequently underwent successful biopsy. All episodes of chest pain resolved after the cannula was removed. There were no recorded hemorrhagic or cardiac complications.
  
  
  CONCLUSIONS
  TJLB can be safely and repeatedly performed from the left IJV when the right IJV is not available or the hepatic anatomy prevents catheterization of the hepatic veins from the right IJV.
authors.affiliation: Oregon Health and Science University, Dotter Interventional Institute, Portland, Ore., USA. kivilcimyvz@yahoo.com
authors.forename: Kivilcim
authors.initials: K
authors.lastname: Yavuz
authors.forename: Serdar
authors.initials: S
authors.lastname: Geyik
authors.forename: Robert E
authors.initials: RE
authors.lastname: Barton
authors.forename: Bryan
authors.initials: B
authors.lastname: Petersen
authors.forename: Paul
authors.initials: P
authors.lastname: Lakin
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Keller
authors.forename: John A
authors.initials: JA
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D007601:Jugular Veins; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies