Informed Consent：知情同意.pptVIP

Transjugular Liver Biopsy Indications Patients with diffuse liver disease requiring biopsy with 1 or more of the following conditions: Deranged coagulation Massive ascites Liver abnormalities such as peliosis hepatitis In combination with transjugular intrahepatic portosystemic shunt (TIPS) or venography Any other contraindication for percutaneous biopsy Failed percutaneous biopsy Morbid obesity Soft indication for pressure measurement to determine functional portal hypertension Complications The complications are access site - related and cardiac or hepatic complications. Liver capsule puncture Liver hematoma Hematobilia Cardiac arrythmia Portal vein – Arterial/Bilious fistula Psuedoaneurysm Renal failure/Contrast reaction All vascular access complications. Death The reported total complication rate is 7.1%. ( 1.3-20.2% depending on the source) Mortality rates of 0.09% (adults) and 0.1% (children) have also been reported. Mortality is due to hemorrhage from the liver or ventricular arrhythmia. Other complications included neck pain, hematoma in the neck, carotid artery puncture, pneumothorax A technical success rate of 96.8% has been reported in a recent meta-analysis that included more than 7500 cases. (3.2% conversion rate) Inability to catheterize the RHV was the most common reason (43.3%) for failure. How often is conversion to percutaneous biopsy required? Average fluoroscopy time : 4 min The mean duration of the procedure is 40 min Radiation dose ranges from 0.5 - 1 mSv. How long will the procedure take? How common are nondiagnostic biopsies? Fragmentation rates vary between 10-24% Diagnostic sample rates vary between 2-10% Common Patient Questions Percutaneous Gastrostomy Willis Oglesby (WOG) tube Indications Dysphagia due to neurological disorder Head and neck malignancies requiring surgical therapy or radiation that may inhibit access to nutrition Chronic disease states where the patient cannot fill caloric requirements by oral intake alone Inte