The transjugular approach is favored in patients who have high bleeding risk because it does not require passing a needle through the liver capsule (the surface of the liver). An Interventional Radiologist uses ultrasound and/or x-ray image guidance to puncture the jugular vein and advance a small sheath into the vein draining the liver (hepatic vein). Through the sheath, a biopsy needle is passed through the vein wall and into the surrounding liver tissue to obtain samples. By using this technique, any bleeding that occurs from the biopsy will bleed into the hepatic vein, meaning no loss of blood by the patient. Also, a hepatic vein pressure gradient can be calculated to assess for portal hypertension.