4:15 PM; Abstract No. 132 - The collateral adrenal vein: a reliable landmark for right adrenal vein sampling

Abstract

To compare the rate of successful right adrenal vein sampling (AVS) in the presence of the collateral adrenal vein (CAV). Retrospective review of all consecutive patients with primary hyperaldosteronism (PA) who underwent AVS between April 2009 and April 2012 was performed. A total of 30 patients were identified. Procedural images, cortisol and aldosterone values obtained from sampling of the right adrenal vein (RAV) and inferior vena cava (IVC) were reviewed. Cortisol measurements obtained from RAV samples were divided by measurements from the infra-renal IVC blood samples in order to calculate the selectivity index (SI). An SI > 3 was considered indicative of technically successful RAV sampling. RAV sampling was considered technically successful in 29 out of 30 cases (97%). In cases of successful RAV sampling (29 patients), the CAV was identified in 25 patients (86%). The CAV was visualized in isolation in 16 patients (64%), and in conjunction with visualization of the RAV or right adrenal gland stain in 9 patients (36%). The CAV was not visualized in the one case of unsuccessful right AVS. Visualizing the CAV had a sensitivity of 86.2% for successful right AVS. Visualization of the CAV in isolation or conjunction with visualization of the right adrenal gland or RAV, is likely an excellent indicator of successful catheterization of the RAV. Furthermore, non-visualization of the CAV, the RAV or staining of the right adrenal gland should persuade the operator to continue the search for the RAV.