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Intracardiac Echocardiography (ICE)-Guided External Iliac Transvenous Needle Biopsy of an Extravascular Retroperitoneal Mass

Author(s): Jamie RiChard, Bartley Thornburg, Shamit Desai, Ricky Patel, Scott Resnick


Although image-guided Percutaneous Needle Biopsy (PNB) is established as a safe procedure with a high technical success rate, biopsy target location and patient body habitus can limit procedure success. A 71-year-old with super-morbid obesity and two prior primary malignancies presented for biopsy of new retroperitoneal lymphadenopathy. Abdominal girth resulted in unsuccessful ultrasound and CTguided percutaneous biopsy attempts. An external iliac vein Transvascular Needle Biopsy (TVNB) was performed with a transjugular biopsy set under real-time intravascular ultrasound guidance using a wide-view Intracardiac Echo (ICE) probe. Specifically, midthigh left greater saphenous vein access was obtained for biopsy equipment as common femoral vein access was not obtainable due to body habitus. Biopsy samples were adequate for analysis. There were no vascular complications of vessel wall needle perforation or injury to adjacent structures.