Improved technical success and radiation safety of adrenal vein sampling using rapid, semi-quantitative point-of-care cortisol measurement

Abstract

Success rate and complications of adrenal vein sampling procedures before and after use of the adrenal vein sampling Accuracy Kit. Routine use of the adrenal vein sampling Accuracy Kit device for intraprocedural measurement of cortisol commenced in 2016. Results Technical success rate of adrenal vein sampling increased from 63% of 99 procedures to 90% of 48 procedures ( P = 0.0007) after implementation of the adrenal vein sampling Accuracy Kit. Failure of right adrenal vein cannulation was the main reason for an unsuccessful study. Radiation dose decreased from 34.2 Gy.cm (interquartile range, 15.8-85.9) to 15.7 Gy.cm (6.9-47.3) ( P = 0.009). No complications were noted, and implementation costs were minimal. Conclusions Point-of-care cortisol measurement during adrenal vein sampling improved cannulation success rates and reduced radiation exposure. The use of the adrenal vein sampling Accuracy Kit is now standard practice at our centre.

Radiation exposure of adrenal vein sampling: a German Multicenter Study

“…In addition, centers performing rapid cortisol measurements during AVS showed much higher success rates of >80% in comparison to those without application of this technique ( 28 ). Off note, this was not associated with higher EDs to the patients as similarly documented by a recent study ( 29 ). To avoid repeated AVS, it may therefore be postulated this procedure is performed in centers with sufficient volumes of investigations and that rapid cortisol measurement becomes standard, aiming at success rates comparable to available data ( 28 , 29 ).…”

“…Off note, this was not associated with higher EDs to the patients as similarly documented by a recent study ( 29 ). To avoid repeated AVS, it may therefore be postulated this procedure is performed in centers with sufficient volumes of investigations and that rapid cortisol measurement becomes standard, aiming at success rates comparable to available data ( 28 , 29 ). In addition to implementing changes regarding execution of AVS, radiation exposure should generally be kept in mind, when making the decision to perform AVS, even more so in young patients.…”

Adrenal Vein Sampling: Radiation Dose Reduction on New Angiography Platform

“…[20,21] The first of these is associated with an increased radiation dose, and both are costlier than the conventional catheterization technique described here. The median DAP during AVS in the study was 11.3 Gy.cm 2 , which is lower than previously published reports ranging between 32.5 Gy.cm 2 and 72.2 Gy.cm 2 [8][9][10][11] including on some new generation angiography machines. Some of the differences may be, as some groups use CBCT to improve the success rate at the expense of an increased dose.…”

“…[6] AVS is a technically challenging procedure with a significant learning curve and may result in significant radiation exposure to both patient and operator. [7] The published median dose area product (DAP) for AVS ranges between 32.5 Gy.cm 2 and 72.2 Gy.cm 2 , [8][9][10][11] although doses as low as 15.7 Gy.cm 2 have been reported using the intraprocedural measurement of cortisol. [11]…”

Prevalence, diagnosis and outcomes of treatment for primary aldosteronism

“…A less stringent cut-off permits higher AVS success rate though it potentially compromises specificity [94]. Instead of altering cut-off of SI, a rapid intraprocedure cortisol assay can promote success rate of catheterisation from 50%-73% to 85-97% [95][96][97][98], and its efficacy is currently sought by a randomized prospective study [99]. Lateralisation index (LI) is calculated by aldosterone/cortisol ratio in ipsilateral adrenal venous sample corrected by that ratio in contralateral sample.…”