title: Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years.
abstract: BACKGROUND
  Ultrasonographically guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver. Objective of the study was to determine the extent to which the complication rate for ultrasonographically guided punctures of the liver is affected by less comprehensively studied risk factors.
  
  
  METHODS
  A total of 2,229 liver biopsies were performed in 1,961 patients (55.5% males; 44.5% females). We recorded actual complications and assessed the following risk factors: needle gauge, puncture technique, examiner experience, coagulation status, puncture target (focal lesion versus parenchyma), lesion size, patient sex and age.
  
  
  RESULTS
  he rate of complications stood at 1.2% (n = 27), of which 0.5% (n = 12) were major and 0.7% (n = 15) minor complications. A significant increase in complications involving bleeding was observed with larger-gauge needles compared with smaller-gauge needles and for cutting biopsy punctures compared with aspiration biopsies (Menghini technique). In the bivariate analysis complications were 2.7 times more frequent in procedures performed by experienced examiners compared with those with comparatively less experience. Lower values for Quick's test and higher partial thromboplastin times were associated with a higher rate of bleeding. Neither the puncture target, lesion size or patient sex exerted any measurable influence on the puncture risk. Advanced patient age was associated with a higher rate of complications involving bleeding.
  
  
  CONCLUSIONS
  Our study helps to establish the importance of potential and less comprehensively studied risk factors and may contribute to further reduction in complications rates in routine clinical practice.
authors.affiliation: Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Mueller
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kratzer
authors.forename: Suemeyra
authors.initials: S
authors.lastname: Oeztuerk
authors.forename: Manfred
authors.initials: M
authors.lastname: Wilhelm
authors.forename: Richard Andrew
authors.initials: RA
authors.lastname: Mason
authors.forename: Ren
authors.initials: R
authors.lastname: Mao
authors.forename: Mark Martin
authors.initials: MM
authors.lastname: Haenle
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000009:adverse effects* / Q000379:methods; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000097:blood / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009339:Needles / Q000009:adverse effects; D016017:Odds Ratio; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011517:Prothrombin Time; D012307:Risk Factors; D012737:Sex Factors; D018084:Ultrasonography, Interventional; D055815:Young Adult