Biopsy and Drainage · IR Playbook

Transjugular Liver Biopsy and Hepatic Venous Pressure Measurement (TJLB with HVPG)

Transjugular liver biopsy obtains non-targeted hepatic tissue through a hepatic vein and permits hepatic venous pressure gradient measurement during the same venous access. Balloon-occluded wedged hepatic venous pressure approximates sinusoidal portal pressure, while free hepatic venous pressure represents the systemic venous reference; therefore, HVPG accurately quantifies sinusoidal but may underestimate presinusoidal portal hypertension. TJLB is preferred when percutaneous biopsy is unsafe because of ascites or impaired haemostasis, with major complications occurring in approximately 1% of procedures.

What this playbook covers

• Indications
• Contraindications
• Pre-procedure
• Anatomy and Planning
• Equipment
• Procedure Steps
• Technical Endpoints
• Variants
• Troubleshooting
• Complications
• Post-procedure Care
• References

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