Percutaneous transhepatic liver biopsy with tract embolization

PURPOSE: To determine the success and safety of percutaneous transhepatic liver biopsy with tract embolization (PETE) in patients at risk for standard transhepatic biopsy. MATERIALS AND METHODS: Eighty biopsies were performed in 76 patients with diffuse liver disease: 57 biopsies in patients with coagulopathy (11 of whom also had ascites), 16 in patients with mild coagulopathy and ascites, and seven in patients with ascites only. Biopsy was performed with a cutting needle placed through a 10-cm vascular sheath. Gelatin sponge was the embolization agent RESULTS: All 80 biopsy specimens (100%) were adequate for histopathologic diagnosis. Six complications (8%) resulted from the procedure: one bleeding complication due to incomplete tract embolization, two bowel injuries, one hemobilia, one intercostal artery injury, and one posterior liver capsule perforation with bleeding. All complications occurred in patients with coagulopathy and with the operator's first or second PBTE. CONCLUSION: PETE produces excellent diagnostic specimens. The high complication rate empirically appears to be related to the degree of coagulopathy and operator experience.