Simultaneous bilateral adrenal vein sampling for primary aldosteronism: useful tips to make it simple and safe

Lupi, Amalia; Battistel, Michele; Barbiero, Giulio; Miotto, Diego; Rossi, Gian Paolo; Quaia, Emilio

doi:10.1007/s00330-019-06209-5

Cited by 11 publications

(9 citation statements)

References 22 publications

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“…Primary hyperaldosteronism (PA) has nowadays emerged as the most common cause of endocrine hypertension with a reported prevalence of > 10% and strong evidence of an increased risk of cardiorenal complications following hypertension-induced damage to numerous organs [1][2][3][4][5][6]. The majority of patients are diagnosed with either unilateral aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) [1][2][3][4][6][7][8][9][10][11]. With fundamentally different therapeutic strategies and outcomes, distinguishing the subtypes and patients adequately treated by adrenalectomy becomes crucial.…”

Section: Introductionmentioning

confidence: 99%

Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings

et al. 2021

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Purpose To evaluate the feasibility and effect of an approach to adrenal venous sampling (AVS) analysis by combining established selective cortisol and aldosterone indices with the acquisition of a collimated C-arm CT(CACTColl). Methods Overall, 107 consecutive patients (45f,62 m; 54 ± 10 years) undergoing 111 AVS procedures without hormonal stimulation from 7/13 to 2/20 in a single institution were retrospectively analysed. Hormone levels were measured in sequential samples of the suspected adrenal veins and right iliac vein, and selectivity indices (SI) computed. Stand-alone SICortisol and/or SIAldosterone ≥ 2.0 as well as SICortisol and/or SIAldosterone ≥ 1.1 combined with positive right-sided CACTColl of the adrenals (n = 80; opacified right adrenal vein) were defined as a successful AVS procedure. Radiation exposure of CACT was measured via dose area product (DAP) and weighed against an age-/weight-matched cohort (n = 66). Results Preliminary success rates (SICortisol and/or SIAldosterone ≥ 2.0) were 99.1% (left) and 72.1% (right). These could be significantly increased to a 90.1% success rate on the right, by combining an adjusted SI of 1.1 with a positive CACTColl proving the correct sampling position. Sensitivity for stand-alone collimated CACT (CACTColl) was 0.93, with 74/80 acquired CACTColl confirming selective cannulation by adrenal vein enhancement. Mean DAPColl_CACT measured 2414 ± 958 μGyxm2, while mean DAPFull-FOV_CACT in the matched cohort measured 8766 ± 1956 μGyxm2 (p < 0.001). Conclusion Collimated CACT in AVS procedures is feasible and leads to a significant increase in success rates of (right-sided) selective cannulation and may in combination with adapted hormone indices, offer a successful alternative to previously published AVS analysis algorithms with lower radiation exposure compared to a full-FOV CACT.

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Section: Introductionmentioning

confidence: 99%

Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings

et al. 2021

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“…Depending on experience and the technique used, there are significant differences in radiation exposure among centers [29,38,39]. In our clinic the median fluoroscopy time and radiation exposure is 16 minutes and less than 4 mSv due to the native, standardized implementation in the lower range of the literature values (fluoroscopy times 16-27 min; effective dose 3.2-29 mSv) [38].…”

Section: Discussionmentioning

confidence: 91%

“…Simultaneous AVS with bilateral puncture and insertion of two angiography catheters with simultaneous bilateral blood sampling to achieve better results are significantly more time-consuming for both the patient and interventionalist and have not been established over the sequential technique in routine practice [39].…”

Section: Discussionmentioning

confidence: 99%

“…Eine simultane NNVBE mit bilateraler Punktion und Einbringen zweier Angiografiekatheter mit gleichzeitiger bilateraler Blutabnahme zur Erzielung eines besseren Ergebnisses sind für den Patienten und Interventionalisten deutlich aufwendiger und haben sich in der Routine nicht gegenüber der sequenziellen Technik durchgesetzt [39].…”

Section: Diskussionunclassified

“…Je nach Erfahrung und verwendeter Technik besteht eine deutlich unterschiedliche Strahlenexposition zwischen durchführenden Zentren [29,38,39]. Die mediane Durchleuchtungszeit und Strahlenexposition in unserer Klinik liegt mit 16 Minuten und unter 4 mSv aufgrund der nativen, standardisierten Durchführung im unteren Bereich der Literaturwerte (Durchleuchtungszeiten 16-27min; effektive Dosis 3,2-29 mSv) [38].…”

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Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

Loberg

Antoch

Stegbauer

et al. 2020

Rofo

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Background Primary aldosteronism (PA) is the most common detectable cause of secondary hypertension. The majority of patients have either an adrenal aldosterone-producing adenoma (APA) or bilateral adrenal hyperplasia (BAH) demanding different therapeutic approaches. Screening tests and imaging cannot reliably distinguish between a unilateral or bilateral PA. Methods This review article gives an overview concerning etiology, diagnostics, and therapeutic options of PA, and reviews the indication, the technique, and relevance of selective adrenal venous sampling (AVS) in the context of the current literature and the authors’ experience. Results AVS can verify or exclude a unilaterally dominated secretion with a high success rate. Patients with PA and a unilateral APA can be treated curatively by adrenalectomy. Conclusions AVS is an established diagnostic examination for differentiation of unilateral from bilateral adrenal disease in patients with PA. Key Points: Citation Format

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Adrenal Vein Sampling

Commander

2022

Diagnosis and Management of Endocrine Disorders in Interventional Radiology

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Simultaneous bilateral adrenal vein sampling for primary aldosteronism: useful tips to make it simple and safe

Cited by 11 publications

References 22 publications

Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings

Adrenal venous sampling in primary hyperaldosteronism: correlation of hormone indices and collimated C-arm CT findings

Update: Selective adrenal venous sampling (AVS) – Indication, technique, and significance

Adrenal Vein Sampling

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