Anomalous adrenal vein anatomy complicating the evaluation of primary hyperaldosteronism

Ford, Kaitlin M.; Smolinski, Sara; Lozada, Juan Carlos Perez

doi:10.1016/j.radcr.2017.09.010

Cited by 6 publications

(3 citation statements)

References 3 publications

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“…Similarly, variants of venous anatomy can complicate AVS during the evaluation of PA. Fujii et al reported a case where AVS was performed in a patient with PA and a left IVC whose left adrenal vein drained directly into the IVC 9. Ford et al presented a case of a rare variant of the left adrenal vein, in which the left gonadal vein drained into the left adrenal vein after taking an atypical course superolateral to the left kidney 10. This anatomical variant also occurred in the context of a patient with PA and complicated AVS.…”

Section: Discussionmentioning

confidence: 99%

Duplicate inferior vena cava complicating the evaluation of primary aldosteronism

et al. 2021

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A 64-year-old man with a known duplicate inferior vena cava (D-IVC) and resistant hypertension presented to our emergency department in a hypertensive crisis. He had a longstanding history of hypertension and unexplained hypokalemia treated with oral potassium supplementation. The patient was diagnosed with primary aldosteronism and MRI of the abdomen revealed a left-sided adrenal adenoma. Adrenal venous sampling (AVS) lateralised aldosterone hypersecretion to the left adrenal gland. The patient subsequently underwent an uncomplicated laparoscopic left adrenalectomy. The patient’s postoperative course was uneventful, and he was discharged on a single antihypertensive medication on postoperative day 1. D-IVC is one of several rare IVC anatomical variants that have been well described in the literature. Knowledge of this patient’s unique abdominal venous anatomy enabled successful AVS and appropriate surgical management. It is necessary to identify potential anatomical variants of abdominal venous anatomy that may complicate these invasive procedures.

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Section: Discussionmentioning

confidence: 99%

Duplicate inferior vena cava complicating the evaluation of primary aldosteronism

et al. 2021

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“…From its origin in the adrenal hilum, it typically travels inferomedially to form a common trunk with the inferior phrenic vein and then drain into the left renal vein. 7,19 Variations occur in less than 10% of patients and most commonly includes duplication of the left adrenal vein or drainage of the left adrenal vein directly into the left renal vein. 20 We found that intraprocedural left renal venogram was sufficient to identify the anatomy of the left adrenal vein and no variant anatomy was observed in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Use of Bony Landmarks during Adrenal Venous Sampling to Guide Catheterization of the Left Adrenal Vein

Cusumano

Mathevosian

Sweigert

et al. 2021

The Arab Journal of Interventional Radiology

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Purpose The aim of this study was to examine the utility of fluoroscopic bony landmarks in predicting the location of the left adrenal vein during adrenal vein sampling (AVS). Methods Eighty-six AVS procedures were performed in 81 patients between August 2013 and March 2020. A selectivity index was calculated for each case by dividing the measured left adrenal vein cortisol level by the peripheral vein cortisol level. Successful “target” left adrenal vein catheterization was confirmed in cases with a selectivity index of three or greater. Intraprocedural AVS fluoroscopic images were selected that demonstrated catheter position in the left adrenal vein. Lateral distance from the catheter tip in the left adrenal vein to the lateral margin of the left pedicle at the associated vertebral body level was measured. Results Mean patient age was 56.4 years (range: 19–80 years) and 48 (59.3%) patients were male. Target sampling in the left adrenal vein was confirmed in 82 (95.3%) cases. In 78 (95.1%) targeted cases, the catheter terminated less than 25 mm from the left lateral pedicle at a mean distance of 11.2 mm. The catheter was most frequently placed at the T12 and L1 vertebral body levels. Four (4.7%) cases demonstrated nontarget catheter positioning, two (50.0%) of these cases were within 25 mm. Conclusion The position of the left adrenal vein is generally located in a predictable position relative to bony landmarks. By utilizing these landmarks, positioning of the sampling catheter during AVS can be more reliable with the potential to avoid repeat procedures and delays in patient care.

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“…Variations in anatomy of the left adrenal vein are rare but must be appreciated by the operator, including the left adrenal vein directly entering the IVC, the gonadal vein, or the lower moiety of a circumaortic left renal vein. [13][14][15] Gentle venography (no more than 2-3 mL) will confirm the location. If the catheter tip position is tenuous, it may be helpful to introduce a coaxial microcatheter to provide a few centimeters of additional length to stabilize the position in the vein [ Figure 2].…”

Section: Sampling Proceduresmentioning

confidence: 99%

Adrenal Vein Sampling: How I Do It

Valji

2019

The Arab Journal of Interventional Radiology

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Adrenal vein sampling (AVS) is an uncommonly performed interventional procedure. However, it is essential in the management of patients with primary aldosteronism and several other rare hormonal disorders. AVS can be technically challenging, largely from difficulty with right adrenal vein catheterization. Recently described technical modifications have improved the likelihood of successful sampling in every case. This paper highlights the author's approach to patient selection and step-by-step details of his technique.

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Anomalous adrenal vein anatomy complicating the evaluation of primary hyperaldosteronism

Cited by 6 publications

References 3 publications

Duplicate inferior vena cava complicating the evaluation of primary aldosteronism

Duplicate inferior vena cava complicating the evaluation of primary aldosteronism

Use of Bony Landmarks during Adrenal Venous Sampling to Guide Catheterization of the Left Adrenal Vein

Adrenal Vein Sampling: How I Do It

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