How is transjugular liver biopsy performed?
A hepatic vein (most commonly the right hepatic vein) is accessed using a transjugular approach (via the jugular vein to the superior vena cava, through the right atrium to the inferior vena cava, and into the right hepatic vein), and a stiff wire is placed. A stiff metal cannula is placed over the wire into the hepatic vein. An 18 G or 19 G core biopsy needle is placed through the cannula and used to obtain multiple samples of liver tissue. Because the right hepatic vein courses posteriorly through the right lobe, the needle is directed anteriorly to avoid transgression of the liver capsule. Because the middle hepatic vein courses more anteriorly, however, lateral or posterior sampling may be safer with this approach.