Abstract No. 599 Adrenal vein sampling: multipurpose catheter shape facilitates sampling in a subset of right adrenal veins

Abstract

Adrenal vein sampling (AVS) is a technically challenging procedure, with failure rates reported as high as 70 percent. AVS failures are commonly attributable to difficulties cannulating the right adrenal vein (RAV). Knowledge of RAV anatomy and anatomic variants can inform proper catheter choice and may greatly influence AVS success rates. Normally, the RAV is caudally oriented at an acute angle to the IVC. Anatomic variants in which the RAV is cranially oriented at various angles to the IVC have been reported in up to 11% of patients. In such patients, use of a multipurpose (MPA) catheter may facilitate RAV sampling. We evaluated the use of an MPA catheter to cannulate cranially oriented right adrenal veins. AVS was performed via right femoral venous access by a single operator, with SI>5 considered diagnostic. Between 2014 and 2018, 272 patients underwent AVS and an MPA catheter was used to cannulate the RAV in 11 patients (4%, 3M/8F). Data regarding pre-AVS imaging, procedural details, and AVS results were retrospectively collected. The RAV angle was calculated using the right lateral wall of the IVC as the craniocaudal axis, with 0° degrees defined as caudal and 180° as cranial. Dedicated pre-procedural imaging to evaluate venous anatomy was not obtained in any patient. A cranially oriented RAV was identified intra-procedurally in all patients (n=11), with a mean angle of 139.4°±20.1° (range 97.4°-168.2°). An MPA catheter was the 2nd choice catheter in 7 patients (63.6%) and at most the 8th choice catheter (n=1, 9%). Mean fluoroscopic time (7.5 pulses/sec) was 16±11 minutes (range 3-39 minutes). Adequate sampling of the right adrenal vein was achieved in all patients, with all SI>5 (mean=24±12, range 10-52). Six patients (55%) were diagnosed with a left aldosteronoma, 1 (9%) with a right aldosteronoma, 3 (27%) with bilateral adrenal hyperplasia, and 1 (9%) had bilaterally suppressed aldosterone-to-cortisol ratios. Identification of cranially oriented RAVs and subsequent catheterization with an MPA catheter facilitates sampling. MPA catheters should be readily considered when cranially oriented RAVs are present.