Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies

Scholten, Anouk; Cisco, Robin M.; Vriens, Menno R.; Shen, Wen T.; Duh, Quan‐Yang

doi:10.1001/jamasurg.2013.610

Cited by 83 publications

(60 citation statements)

References 14 publications

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“…Display of the proper catheter position using a C-arm CT is a current additional option. Perfect positioning should permit selective sampling of the entire adrenal gland; this is difficult, however [37]. It is particularly important to distinguish the right adrenal vein leading directly into the inferior vena cava from small accessory hepatic veins ( • " Fig.…”

Section: Adrenal Venous Sampling Techniquementioning

confidence: 99%

Indication and Technical Aspects of Adrenal Blood Sampling

Blondin

Quack

Kücükköylü

et al. 2014

Fortschr Röntgenstr

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Adrenal disorders are relative frequent with regard to the incidence of adrenal tumors and the high portion in causes of secondary hypertension. Morphological changes in the adrenal glands can lead to very different functional disorders that may be clinically overt or hard to diagnose. On the other hand, they can already be functionally relevant when structural changes are too small to be picked up by imaging. Adrenal venous sampling serves to determine the source of hormone excess through the analysis of adrenal blood. In this manuscript, we call attention to the clinical backgrounds, critical points in praxis, technical aspects and developments in the the field of adrenal venous sampling. The consideration of these important points in the clincal setting may make adrenal vein sampling studies sucessful and help to select patients that qualify for adrenalectomy. Key Points: ??Selective adrenal venous sampling (AVS) currently continues to be the gold standard for localization diagnostics in patients with primary hyperaldosteronism. ??Comprehensive standardization of all preceding examinations and AVS is necessary to ensure high success rates. ??The method is supported by contrast-enhanced imaging for ensuring proper positioning of the catheter in the adrenal veins and the rapid cortisol assay. ??Knowledge of the anatomy and normal variants of the adrenal veins facilitates adrenal venous sampling. Citation Format: ??Blondin D, Quack I, Haase M et?al. Indication and Technical Aspects of Adrenal Blood Sampling. Fortschr R?ntgenstr 2015; 187: 19???28

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Section: Adrenal Venous Sampling Techniquementioning

confidence: 99%

Indication and Technical Aspects of Adrenal Blood Sampling

Blondin

Quack

Kücükköylü

et al. 2014

Fortschr Röntgenstr

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“…Nevertheless, previous anatomical reports gave little attention to the orientation and orificial location of the right adrenal vein1314, which is of paramount importance to AVS procedures. Recently, the presence of Dyna CT and its ability to delineate the vascular structures have increased the success rate of AVS1015.…”

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confidence: 99%

Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism

Lee

Chang

Liu

et al. 2016

Sci Rep

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Primary aldosteronism (PA) is the most common cause of secondary hypertension and consists up to 11% of patients with hypertension. Adrenal venous sampling (AVS) is the recommended procedure for diagnosis of PA, but the technique is difficult and the right adrenal vein is especially hard to catheterize. We retrospectively examined the clinically relevant anatomy of the right adrenal vein in a sample of 66 PA patients with technically successful AVS and distinctly-opacified right adrenal veins in Dyna computed tomography (CT). In the majority of cases: the right adrenal veins were catheterized when the catheter tilted posterior and rightward (57/66, 86.4%), the transverse direction of the right adrenal vein from the inferior vena cava (IVC) was posterior and rightward (55/66, 83.3%), and the vertical direction of the right adrenal vein from the IVC was caudal (52/66, 78.8%). This study shows that Dyna CT is able to provide detailed anatomical information to the course and direction of the right adrenal vein.

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“…of a main adrenal vein, the presence of additional small veins, and a double adrenal vein (12). The right adrenal vein sharing confluence with an inferior accessory right hepatic vein has also been reported (7,13).…”

Section: Potential Hazard Related To the Anatomy Of The Adrenal Veinsmentioning

confidence: 93%

“…The inferior phrenic vein could be preserved in most instances. On the other hand, anatomic variants of the right adrenal vein exist in about 13% of cases and have been found to be related to certain patient-and tumor-related features (12). Anatomic variations include: the absence The superior pole of the kidney is seen below the energy device, and the caudal aspect of the adrenal gland and its surrounding fat have been completely dissected free from it.…”

Section: Potential Hazard Related To the Anatomy Of The Adrenal Veinsmentioning

confidence: 99%

Posterior Retroperitonoscopic Adrenalectomy; How to Do it – Pearls and Secrets

Bakkar

Materazzi

2016

J Minim Invasive Surg Sci

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Background: Since the early 1990s, endoscopic adrenalectomy has become the gold standard surgical approach for the adrenal gland. Also, lateral transperitoneal adrenalectomy (LTA) which is the most widely used approach accompanies that.. Posterior retroperitonoscopic adrenalectomy (PRA) is another safe and effective approach for the adrenal gland. However, it has not gained global popularity. This is largely attributed to the unfamiliarity of surgeons with the ergonomics and executional steps of the procedure, and the relevant retroperitoneal anatomy. Misconceptions held by both surgeons and anesthesiologists regarding the consequences of the high-pressure retroperitoneal insufflation required may also be a contributing factor. The aim of this article is to provide a detailed description of PRA in a manner which allows the proper acquisition of the knowledge required to perform the procedure safely and effectively. Methods: To achieve the objective of this article, it has been broadly divided into three sections including background, operative technique, and comments. The background provides an introduction to the procedure and its advantages. The section about operative technique provides a detailed description of the preoperative preparatory phase, the proper access, and the executional steps of the procedures supplemented with illustrative figures. It also provides insight into potential hazards related to the anatomy of the adrenal veins, and the means of dealing with variant anatomy. The comments' section deals with the procedure's learning curve, and the factors affecting it. It also describes the ideal case for the commencement of the learning curve. A clarification of the misconceptions surrounding PRA is also provided in this section. Conclusion: With thorough technical knowledge and an adequate learning curve, PRA could serve as the surgeon's preferred surgical approach to the adrenal gland within the confines of its selection criteria.

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Variant Adrenal Venous Anatomy in 546 Laparoscopic Adrenalectomies

Cited by 83 publications

References 14 publications

Indication and Technical Aspects of Adrenal Blood Sampling

Indication and Technical Aspects of Adrenal Blood Sampling

Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism

Posterior Retroperitonoscopic Adrenalectomy; How to Do it – Pearls and Secrets

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