Navigating Through the Veins: A Pictorial Review of Intravascular Ultrasound-Guided Transvenous Biopsies of Percutaneously Inaccessible Lesions

Monday, April 13, 2026

4:51 PM - 4:57 PM ET

Location: 717

Abstract Presenter(s)

UH

Usama Habib, MD, MBBS

Resident
UTMB, United States

Author/Co-author(s)

SJ

Sania Javed, MBBS

Research Fellow
University of Texas Medical Branch at Galveston (UTMB), United States
AR

Ahmad Raza, MBBS

Resident
Aga khan university hospital, Karachi, Pakistan
MM

Mallick Mohammad Zohaib Uddin, MBBS

Resident
Aga Khan University Hospital, Karachi, Pakistan
Irfan Masood, MD

Assistant Professor of Radiology
University of Texas Medical Branch, United States
UZ

Uffan Zafar, MD

Fellow
University of Texas Medical Branch, Galveston, Texas, USA, United States
AS

Arsalan Saleem, MD

Program Director
UTMB Galveston, Diagnostic & Interventional Radiology, United States

Learning Objectives:

To review the role of intravascular ultrasound (IVUS) guided transvenous biopsies in accessing the lesions not amenable to percutaneous approaches

To illustrate the procedural technique, equipment, and pre/post-procedural considerations using case-based pictorial examples.

To highlight the diagnostic yield, safety profile, and clinical scenarios where this approach offers significant advantages.

Background: Percutaneous biopsy is considered the gold standard for tissue sampling, but it may be contraindicated in certain scenarios due to lesion location, overlying viscera, vascular proximity, coagulopathy, or ascites. In such cases, transvenous biopsy offers a minimally invasive alternative, providing safe access to perivascular, intravascular, hepatic, renal, retroperitoneal, and pelvic lesions. With the advent of intravascular ultrasound and intracardiac echocardiography, transvenous biopsy has evolved into a precise and effective technique with diagnostic accuracy approaching that of percutaneous methods.

Clinical Findings/Procedure Details: Pre-procedure workup: Laboratory thresholds, anticoagulation management, and sedation considerations.

Equipment and technique: Venous access (femoral/jugular), IVUS probe types (radial vs side-firing), biopsy devices (TLAB, Chiba needle, BRK transseptal), and use of fluoroscopy/cone-beam CT for lesion targeting.

Stepwise workflow: Venography, IVUS lesion identification, biopsy needle alignment, tissue acquisition, and adequacy confirmation.

Complications: Low incidence of bleeding, venous injury, or thrombosis; illustrative cases of adverse events and their management.

Case-based pictorial review: Four representative cases (schwannoma, iliac vein mass, hepatic lesion adjacent to IVC, and iliac lymphadenopathy) with multimodality imaging and procedural illustrations.

Conclusion and/or Teaching Points: IVUS-guided transvenous biopsy is a safe and effective alternative when percutaneous biopsy is not feasible.

A stepwise approach with careful pre-procedure preparation and imaging guidance ensures high diagnostic yield and minimal complications.

A pictorial case-based review highlights the versatility of this technique across different anatomical locations, reinforcing its role in modern interventional radiology practice.