Technical Aspects of Adrenal Vein Sampling

Harsha, Asheesh; Trerotola, Scott O.

doi:10.1016/j.jvir.2014.11.006

Cited by 11 publications

(6 citation statements)

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“…Remove all catheters and access sheath, and complete the cAVS and ssAVS examinations after astriction. NOTE: Regarding details on the general adrenal venous sampling technique (steps except for 3.2), refer to other textbooks or journals 17 .…”

Section: Protocolmentioning

confidence: 99%

A Novel Method: Super-selective Adrenal Venous Sampling

Makita

Nishimoto

Kiriyama-Kitamoto

et al. 2017

JoVE

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Primary aldosteronism (PA) and subclinical Cushing's syndrome (SCS) are conditions in which the adrenal glands autonomously produce excessive amounts of aldosterone and cortisol, respectively. The conventional adrenal venous sampling (cAVS) method collects blood samples from both adrenal central veins and is useful for identifying the laterality of excess hormone production in a unilateral lesion(s), as documented in PA cases. In cAVS, plasma cortisol concentrations (PCCs) are used to normalize plasma aldosterone concentrations (PACs). A novel "super-selective" adrenal venous sampling (ssAVS) method was developed using a micro-catheter, which collects blood samples from adrenal tributary veins (TVs). PACs in ssAVS samples do not require PCC normalization because samples contain a limited amount of systemic venous blood, if any. The ssAVS method enabled segmental lesion(s) to be detected in both adrenal glands, which may be treated by bilateral adrenalectomy, thereby sparing lesion-free segment(s). Right and left adrenals typically have three TVs each, i.e., the superior, lateral, and inferior TVs in the right adrenal as well as the superior-median, superior-lateral, and lateral TVs in the left adrenal. In the ssAVS method, specific parent catheters and a technique to handle them are required, and have been described herein. Furthermore, ssAVS results from three cases of PA are presented: bilateral aldosterone-producing adenoma (APA) (Case #1), left APA and right possible cortisol-producing adenoma causing SCS (Case #2), and idiopathic hyperaldosteronism in which bilateral adrenal segments produced excessive amounts of aldosterone (Case #3). The ssAVS method is not difficult for expert angiographers, and, thus, is recommended worldwide to treat PA cases for which cAVS does not represent a viable surgical treatment option.

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Section: Protocolmentioning

confidence: 99%

A Novel Method: Super-selective Adrenal Venous Sampling

Makita

Nishimoto

Kiriyama-Kitamoto

et al. 2017

JoVE

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“…Although the rate of bilaterally successful cannulation during AVS may be higher than 90% when performed by an experienced radiologist 19 , several centers do not have a comparable reliability, with a successful rate ranging between 8.0 and 30.5%, especially where a low number of AVS are performed per year [20][21][22] . Given its course and anatomical variability 23 , the main reason for unsuccessful AVS is the failed cannulation of RAV because of difficulties in identification of the vessel.…”

Section: Discussionmentioning

confidence: 99%

Prediction of hyperaldosteronism subtypes when adrenal vein sampling is unilaterally successful

Burrello

Pieroni

et al. 2020

European Journal of Endocrinology

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Objective – Adrenal venous sampling (AVS) is the gold standard to discriminate patients with unilateral primary aldosteronism (UPA) from bilateral disease (BPA). AVS is technically-demanding and in cases of unsuccessful cannulation of adrenal veins, the results may not be interpreted. The aim of our study was to develop diagnostic models to distinguish UPA from BPA, in cases of unilateral successful AVS and the presence of contralateral suppression of aldosterone secretion. Design – Retrospective evaluation of 158 patients referred to a tertiary hypertension unit who underwent AVS. We randomly assigned 110 patients to a training cohort and 48 patients to a validation cohort to develop and test the diagnostic models. Methods – Supervised machine learning algorithms and regression models were used to develop and validate two prediction models and a 19-point score system to stratify patients according to subtype diagnosis. Results – Aldosterone levels at screening and after confirmatory testing, lowest potassium, ipsilateral and contralateral imaging findings at CT scanning, and contralateral ratio at AVS, were associated with a diagnosis of UPA and were included in the diagnostic models. Machine learning algorithms correctly classified the majority of patients both at training and validation (accuracy 82.9-95.7%). The score system displayed a sensitivity/specificity of 95.2/96.9%, with an AUC of 0.971. A flow-chart integrating our score correctly managed all patients except 3 (98.1% accuracy), avoiding the potential repetition of 77.2% of AVS. Conclusions – Our score could be integrated in clinical practice and guide decision-making in patients with unilateral successful AVS and contralateral suppression.

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“…All procedures were performed by a single operator with more than 20 years of experience in AVS. Post-stimulation sampling was performed from a right femoral approach with sequential catheterization starting with the right adrenal vein, followed by the left adrenal vein, and IVC as previously described [7][8][9]. No pre-stimulation sampling was performed.…”

Section: Protocol For Withdrawal Of Antihypertensives and Technique Fmentioning

confidence: 99%