Comparative Success and Safety of Transjugular versus Transfemoral Liver Biopsies in Patients with Fontan-associated Liver Disease

Tuesday, April 1, 2025

3:27 PM – 3:36 PM CT

Location: Music City Center, 207 CD

Presenting Author(s)

EK

Eleanor Kim, MD

Resident Physician in Interventional/Diagnostic Radiology
New York Presbyterian/Columbia, United States
JD

Juhi Deolankar, MD

Resident Physician
New York Presbyterian/Columbia University, United States

Author/Co-author(s)

MT

Mari Tassarotti, MD

Assistant Professor Interventional Radiology
Columbia University, United States
SB

Sidney Brejt, MD

Associate Professor
Columbia University, United States
RP

Rooshi Parikh, BS

Medical Student
The City University of New York, United States

Purpose: Patients with history of Fontan surgical procedures for congenital cardiac disease are at risk for Fontan-associated liver disease (FALD) and are frequently evaluated with transvenous liver biopsy and pressure measurements. Technical challenges can present during the case due to the configuration of post-Fontan anatomy and concerns about traversing the shunt by the operator. Both transfemoral and transjugular approaches for this patient population have been described [1]. Here we describe our institution's large-volume experience performing transjugular and transfemoral liver biopsy in patients with concern for Fontan-associated liver disease and compare the safety and technical success between those patients undergoing transjugular and transfemoral approach biopsies.

Materials and Methods: An IRB approved retrospective analysis of 77 transvenous liver biopsy procedures in patients with history of Fontan surgery performed between 1991 and 2023. Patient demographics including type of Fontan surgical anatomy, complications, technical success, histopathologic success and radiation dose (mGy) and fluoroscopy time were measured. Complication and success rates between those patients undergoing transjugular and transfemoral approaches were also compared.

Results: A total of 77 procedures were performed in 77 patients. 47/77 of the procedures were performed concurrently with cardiac catheterization. 70 were performed via transjugular route and 7 were performed via transfemoral route. The technical success was obtained in 100% of the cases via the transjugular route and 85.7 % in the transfemoral route. There was 100% histopathologic success in both groups. Complication rates were statistically significant with all being in the transjugular group (6/70) and none in the transfemoral group. Fluoroscopy time between the two was statistically significant (p < 0.0001) with 12.9 min in the transfemoral and 5.8 min in the transjugular group. Mean radiation dose was statistically significant (p = 0.003) with 144.2 mGy in the transfemoral and 45.8 mGy in the transjugular group.

Conclusion:
This larger cohort single institution study comparing transjugular versus transfemoral route biopsies performed in FALD patients were deemed to be safe and effective in yielding technical and histopathological success. The transfemoral approach yielded no complications compared to the transjugular group and also had a very high technical success rate, making it a potentially safer and favorable method of obtaining biopsies in the FALD patients.