Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures

Jakobsson, Hugo; Farmaki, Katerina; Sakinis, Augustinas; Ehn, Olof; Johannsson, Gudmundur; Ragnarsson, Oskar

doi:10.5152/dir.2018.17397

Cited by 38 publications

(52 citation statements)

References 21 publications

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“…Several years ago, we reported five key factors for a successful AVS programme: (i) appropriate patient selection; (ii) careful patient preparation; (iii) focused technical expertise; (iv) a defined written protocol; and (v) accurate data interpretation . Multiple interventional radiologists at one centre participating in the AVS programme leads to decreased volume of cases per radiologist and poor catheterization success rates . In addition, a centre‐specific, written protocol should be developed by an interested group of endocrinologists, hypertension specialists, internists, interventional radiologists and laboratory personnel .…”

Section: Diagnosismentioning

confidence: 99%

“…This method remains the gold standard test to distinguish unilateral from bilateral disease in patients with PA [11,34,61,65,69,70,75]. AVS is a technically demanding procedure because the right adrenal vein is small and may be difficult to locate and cannulate; the success rate depends on the expertise and engagement of the interventional radiologist [72,74]. The success rate for cannulation of the right adrenal vein in 384 patients from 47 studies was 74% [13].…”

Section: Adrenal Vein Samplingmentioning

confidence: 99%

“…The success rate for cannulation of the right adrenal vein in 384 patients from 47 studies was 74% [13]. However, the AVS success rate can be as high as 96%, an outcome attributed to focusing expertise to one or two radiologists at high-volume referral centres [61,69,72,74,76,77].…”

Section: Adrenal Vein Samplingmentioning

confidence: 99%

“…Multiple interventional radiologists at one centre participating in the AVS programme leads to decreased volume of cases per radiologist and poor catheterization success rates [73,74,78,79]. In addition, a centre-specific, written protocol should be developed by an interested group of endocrinologists, hypertension specialists, internists, interventional radiologists and laboratory personnel [72,78].…”

Section: Adrenal Vein Samplingmentioning

confidence: 99%

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Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

2018

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Primary aldosteronism (PA), the most common form of secondary hypertension, can be either surgically cured or treated with targeted pharmacotherapy. PA is frequently undiagnosed and untreated, leading to aldosterone‐specific cardiovascular morbidity and nephrotoxicity. Thus, clinicians should perform case detection testing for PA at least once in all patients with hypertension. Confirmatory testing is indicated in most patients with positive case detection testing results. The next step is to determine whether patients with confirmed PA have a disease that can be cured with surgery or whether it should be treated medically; this step is guided by computed tomography scan of the adrenal glands and adrenal venous sampling. With appropriate surgical expertise, laparoscopic unilateral adrenalectomy is safe, efficient and curative in patients with unilateral adrenal disease. In patients who have bilateral aldosterone hypersecretion, the optimal management is a low‐sodium diet and lifelong treatment with a mineralocorticoid receptor antagonist administered at a dosage to maintain a high–normal serum potassium concentration without the aid of oral potassium supplements.

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Section: Diagnosismentioning

confidence: 99%

Section: Adrenal Vein Samplingmentioning

confidence: 99%

Section: Adrenal Vein Samplingmentioning

confidence: 99%

Section: Adrenal Vein Samplingmentioning

confidence: 99%

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Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

2018

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“…AVS was performed and registered in 140 patients, and the data display a correlation between lateralisation ratio and clinical outcome. AVS is known to be technically challenging and dependent on the operator [36]. In particular, the right adrenal vein is more difficult to cannulate than the left.…”

Section: Discussionmentioning

confidence: 99%

Outcomes After Surgery for Unilateral Dominant Primary Aldosteronism in Sweden

et al. 2019

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Background Primary aldosteronism (PA) is the most common cause of secondary hypertension. Surgery is the mainstay of treatment for unilateral dominant PA, but reported cure rates varies. The aim of the present study was to investigate contemporary follow-up practices and cure rates after surgery for PA in Sweden. Methods Patients operated for PA and registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009-2015 were identified. Patient data were extracted, and follow-up data (1-24 months) was recorded. Doses of antihypertensive medication and potassium supplementation were calculated using defined daily doses (DDD), and the Primary Aldosteronism Surgical Outcome (PASO) criteria were used to evaluate outcomes. Results Of 190 registered patients, 171 (47% female, mean age 53 years, median follow-up 3.7 months) were available for analysis. In 75 patients (44%), missing data precluded evaluation of biochemical cure according to the PASO criteria. Minimal invasive approach was used in 168/171 patients (98%). Complication rate (Clavien-Dindo [3a) was 3%. No mortality was registered. Pre/postoperatively 98/66% used antihypertensives (mean DDD 3.7/1.5). 89/2% had potassium supplementation (mean DDD 2.0/0) before/after surgery. Complete/partial biochemical and clinical success according to the PASO criteria were achieved in 92/7% and 34/60%, respectively. Conclusion In this study, reflecting contemporary clinical practice in Sweden complete/partial biochemical and clinical success after surgery for PA was 92/7% and 34/60%. Evaluation of biochemical cure was hampered by lack of uniform reporting of relevant outcome measures. We suggest mandatory reporting of surgical outcomes using the PASO criteria for all units performing surgery for PA.

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Association of Adrenal Venous Sampling With Outcomes in Primary Aldosteronism for Unilateral Adenomas

et al. 2021

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Adrenal venous sampling is recommended prior to adrenalectomy for all patients with hyperaldosteronism; however, cross-sectional imaging resolution continues to improve, while the procedure remains invasive and technically difficult. Therefore, certain patients may benefit from advancing straight to surgery. OBJECTIVE To determine whether clinical and biochemical resolution varied for patients with primary aldosteronism with unilateral adenomas who underwent adrenal venous sampling vs those who proceeded to surgery based on imaging alone. DESIGN, SETTING, AND PARTICIPANTS Retrospective, international cohort study of patients treated at 3 tertiary medical centers from 2004 to 2019, with a median follow-up of approximately 6 months. A total of 217 patients were consecutively enrolled. Exclusion criteria consisted of unknown postoperative serum aldosterone level and imaging inconsistent with unilateral adenoma with a normal contralateral gland. A total of 125 patients were included in the analysis. Data were analyzed between October 2019 and July 2020.EXPOSURES Adrenal venous sampling performed preoperatively. MAIN OUTCOMES AND MEASURESThe primary outcome measurements were the clinical and biochemical success rates of surgery for the cure of hyperaldosteronism secondary to aldosterone-producing adenoma.RESULTS A total of 125 patients were included (45 cross-sectional imaging with adrenal venous sampling and 80 imaging only). The mean (SD) age of the study participants was 50.2 (10.6) years and the cohort was 42.4% female (n = 53). Of those patients for whom race or ethnicity were reported (n = 80), most were White (72.5%). Adrenal venous sampling failure rate was 16.7%, and the imaging concordance rate was 100%. Relevant preoperative variables were similar between groups, except ambulatory systolic blood pressure, which was higher in the imaging-only group (150 mm Hg; interquartile range [IQR], 140-172 mm Hg vs 143 mm Hg, IQR, 130-158 mm Hg; P = .03). Resolution of autonomous aldosterone secretion was attained in 98.8% of imaging-only patients and 95.6% of adrenal venous sampling patients (P = .26). There was no difference in complete clinical success (43.6% [n = 34] vs 42.2% [n = 19]) or partial clinical success (47.4% [n = 37] vs 51.1% [n = 23]; P = .87) between groups. Complete biochemical resolution was similar as well (75.9% [n = 41] vs 84.4% [n = 27]; P = .35). There was no difference in clinical or biochemical cure rates when stratified by age, although complete clinical success rates downtrended in the older cohorts, and sample sizes were small. CONCLUSIONS AND RELEVANCEGiven the improved sensitivity of cross-sectional imaging in detection of adrenal tumors, adrenal venous sampling may be selectively performed in appropriate patients with clearly visualized unilateral adenomas without affecting outcomes. This may facilitate increased access to surgical cure for aldosterone-producing adenomas and will decrease the incidence of morbidities associated with the procedure.

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Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures

Cited by 38 publications

References 21 publications

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

Diagnosis and treatment of primary aldosteronism: practical clinical perspectives

Outcomes After Surgery for Unilateral Dominant Primary Aldosteronism in Sweden

Association of Adrenal Venous Sampling With Outcomes in Primary Aldosteronism for Unilateral Adenomas

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