Selective Venous Sampling in Recurrent and Persistent Hyperparathyroidism: Indication, Technique, and Results

Abstract

Between 1992 and 2002, 542 patients underwent a surgical treatment for hyperparathyroidism in our department. Twenty-three selective venous sampling procedures (SVS) were performed because of the failure of the other methods of diagnosis. These patients have recurrent or persistent hyperparathyroidism. Noninvasive methods of topographical diagnosis have failed or they have given contradictory results. In our experience, the surgeon needs a precise localization of the pathological glands in these difficult cases. In our series of SVS, specificity was 85.7% and sensitivity was 94.7%. Our results show that a high postoperative gradient of parathyroid hormone in the internal thoracic veins indicates an ectopic pathological gland in the thymus. A high gradient in a vertebral vein indicates a pathological superior parathyroid gland, usually in a retro-esophageal position.

Super-selective venous sampling in conjunction with quickPTH for patients with persistent primary hyperparathyroidism: report of five cases

“…In this study, the time from when the first sample was taken during the first round until when the last sample was taken during super-SVS, including the quick PTH results, ranged from 90-135 min (mean, 115 min). This time has to be weighed against the time it would take to catheterize all small neck veins (29) and should be addressed in larger studies.…”

Venous Procedures

“…Sampling of the internal thoracic and vertebral veins has been advocated to look for ectopic locations of parathyroid adenomas. 39 Other endocrine tumors can be localized by venous sampling, but those procedures are beyond the scope of this handbook. …”

A novel technique in selective venous sampling in the localization of parathyroid tumours utilizing a micro-wire and standardized catheter

“…The diagnosis of primary or tertiary hyperparathyroidism is initially made on biochemical grounds with elevation of serum calcium levels and parathyroid hormone [1]. Once surgery is contemplated as a treatment modality, many surgeons require preoperative localization of the parathyroid tumour.…”