The Use of the Transfemoral Transcaval Liver Biopsy Technique for Biopsies of Hepatic Masses

Purpose: To describe our experience with the use of the transfemoral transcaval liver biopsy (TFTC) technique in patients with hepatic masses with contraindications to percutaneous liver biopsy and/or with intrahepatic lesions that abut or are adjacent to the inferior vena cava (IVC)

Materials and Methods: In patients with contraindications to percutaneous liver biopsies, which include perihepatic ascites, coagulopathy, thrombocytopenia, morbid obesity, an atrophic liver, or in patients with intrahepatic lesions that are either close to or abut the IVC, TFTC is a viable alternative technique. TFTC is a technique in which hepatic tissue is directly obtained through the intrahepatic IVC via a femoral venous approach. In this retrospective case series, the medical, surgical, and radiologic records of patients who underwent TFTC of hepatic masses at a single tertiary care institution between September 2015 and September 2019 were reviewed.

Results: There were a total of 12 cases of TFTC for hepatic masses from 11 patients. The indications for biopsy via the TFTC technique include 4 cases of perihepatic ascites, 2 cases of coagulopathy, and 6 cases in which the tumor was located in the right hepatic dome adjacent to the IVC and not amenable to percutaneous liver biopsy. Histopathologic diagnoses were successfully made in all cases.

Conclusions: TFTC should be considered for the biopsy of hepatic masses in patients with contraindications to percutaneous liver biopsy or with intrahepatic lesions that abut or are adjacent to the IVC.