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

The safety of transfemoral transcaval (TFTC) liver biopsies was reviewed in 657 cases performed at a single institution between February 2014 and February 2024, highlighting 3 severe adverse events (AEs). The retrospective review was performed for all TFTC liver biopsies. Technical success was attained in 99.4% of cases (n = 653), and histopathologic diagnosis was possible in 97.1% of cases (n = 638). Twenty-three mild (3.5%), 1 moderate (<1%), and 8 severe (1.2%) AEs were reported. Three severe AEs were directly related to biopsy: 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 demonstrated a favorable safety and effectiveness profile. Attention must be paid to avoid low punctures inferior to the intrahepatic IVC because they may be associated with AEs.