Indications

• Suspected hepatic parenchymal disease with contraindication to or failure of percutaneous biopsy

  • • Most commonly: uncorrectable coagulopathy, recent liver transplant, or acute liver failure with high risk for bleeding

• Need for biopsy with portal pressure measurements (hepatic manometry)

Contraindications

• Inadequate venous access site

• Hepatic vein occlusion

• Severe, uncorrectable coagulopathy (often will attempt anyway if essential)

Imaging Review

• Review available imaging for access site problems, hepatic vein patency, and variant anatomy.

Tips for Workup

• Can pt turn neck to left? Neck immobility and airway issues can cause difficulty introducing sheath into right IJ vein.

• Consent:

  • • Intraparenchymal or intraperitoneal hemorrhage, arrhythmia, air embolism, RUQ/shoulder pain (temporary), infection.