May 7th 2011 - Transvenous liver biopsy

On Thursday I had my liver biopsy. A Transvenous liver biopsy is used when a person’s blood clots slowly or if he or she is obese or when excess fluid is present in the abdomen, a condition called ascites. I have all of the above.

During the procedure, patients lie on their back on an x-ray table and a local anesthetic is applied to one side of the neck. If needed, an IV tube is used to give sedatives and pain medication. 

A small incision is made in the neck and a specially designed hollow tube called a sheath is inserted into the jugular vein. The doctor threads the sheath down the jugular vein, along the side of the heart, and into one of the hepatic veins, which are located in the liver. To see the veins, the doctor injects liquid contrast material into the sheath. The contrast material lights up when x rayed, highlighting the blood vessels and showing the location of the sheath.

The doctor threads a biopsy needle through the sheath and into the liver and a liver sample is quickly withdrawn. Several samples may be collected, requiring multiple needle insertions. The sheath is carefully withdrawn and the incision is closed with a bandage. They took six biopsies from me and a series of pressure test (I really don't know what the pressure tests were all about.).

Step by step: I went into the "surgical prep" room about an hour before the procedure. The nurse setup my IV and gathered virtually every fact about my life-time medical history. At precisely 1:30pm they took me to an operating room with the biggest x-ray machine I have ever seen. It was like a 10 foot diameter swiveling arm thing. There was also a bank of 40" flat screens. I thought I would be able to watch, but they put an open ended pup tent on my head so that they operating area remained sterile. 

The anesthesiologist gave me some pain medication and 10cc's of some sedative through my IV. The surgeon gave me local around the insertion spot on my neck and then they began. 

I felt a lot of pressure on my neck and then an odd kind of pressure in my torso as the lead was fed down to my liver. I had an odd bend in my vein and it hurt when they tried to work through it. My blood pressure went through the roof and I lost count of how many painkiller shots they were putting into my IV. Ultimately, they took the six biopsies. I think I was in there for about an hour or so.

Then I went to post op where I had a ham sandwich waiting for me. They kept me for an hour for observation and then I was released. As the painkillers died off the mother of all headaches arrived and stayed through the rest of the day and well into the next day. I took my sleeping meds and tried to ride it out.  


On Friday I still felt horrible and my spleen hurt a lot, but this morning I feel much better. I still have some mild pain in my spleen, but I'm not too worried about it. I'll probably find out the results by Wednesday.


If it is just a fatty liver, I will need to lose weight. Duh. And if it is further along I will need to lose weight. Duh. If it is to the point of cirrhosis, then I may be in trouble.