Use of the external jugular vein approach for transvenous liver biopsy.

Transjugular liver biopsy (TJLB) with use of a right external jugular vein (EJ) approach obviates a deep neck puncture, thereby reducing the risk associated with the procedure in patients with severely disordered coagulation. The EJ approach was successful in 21 of 24 consecutive patients referred for TJLB (88%). The approach was unsuccessful in three cases due to thrombosis or congenital absence of the right EJ. TJLB via the right EJ was successful in all cases in which EJ access could be obtained. In the 21 successful cases, the EJ approach simplified the procedure and shortened its duration. There were no procedure-related complications attributable to the EJ approach. The authors now use the EJ route routinely for patients undergoing TJLB and other transjugular procedures in their laboratory. The EJ approach is particularly recommended in patients with impaired coagulation.