Transfemoral Transcaval Liver Biopsy: A Single Center Experience in 657 Cases.

This study reviews 657 transvenous liver biopsies using a transfemoral transcaval (TFTC) approach performed at a single institution between February 2014 and February 2024, highlighting three severe adverse events (AE). The retrospective review was performed for all TFTC liver biopsies. Technical success was attained in 99.4% of cases (n=653), and histopathological success in 97.1% of cases (n=638). Twenty-three mild (3.5%), one moderate (<1%), and eight severe (1.2%) AEs were reported. Three severe AEs were directly biopsy-related: a gastrointestinal bleed, a gallbladder fossa hemorrhage, and an extrahepatic bile duct leak. Review of the imaging suggests that these biopsies were taken at a point inferior to the intrahepatic inferior vena cava (IVC) which may have led to extrahepatic puncture. The TFTC approach demonstrates a favorable safety and efficacy profile. Importantly, careful attention must be paid to avoid low punctures inferior to the intrahepatic IVC, as they may be associated with AEs.