SIMULTANEOUS ADRENAL VEIN SAMPLING WITH SUBSEQUENT SEQUENTIAL SECOND LEFT SAMPLING: A NEW PERSPECTIVE IN PRIMARY ALDOSTERONISM

Abstract

Objective: Adrenal venous sampling (AVS) is a technically challenging procedure that has its limitations because of a potentially unestimated risk of tube inversion between right (RAVS) and left (LAVS) adrenal venous sampling, which can lead to operating the wrong side in patients with lateralized PA. The aim of this study is to evaluate whether a subsequent sequential second left adrenal venous sampling (LAVS2) can ensure a higher success rate of the procedure and limit the risk of tube inversion in patients who underwent a simultaneous AVS. Design and method: This an observational retrospective study conducted at the Hypertension Unit at Georges-Pompidou European Hospital in Paris, France, that analyzes patients who underwent an AVS between first June 2015 and end of May 2021. The difference between all three AVS was tested using Mann-Whitney test. A random sampling of 100 patients was distributed to 6 physicians, 2 times in a 5-day interval, to test whether they can identify LAVS1 and RAVS based on LAVS2 and to compare between categories: lateralized versus non-lateralized PA, experts versus not experts physicians, at day 1 and day 5. Results: Among the 408 patients, the median age was 46 years. Lateralized PA was found in 216 patients (52.9%). (LAVS2-LAVS1) was inferior to (LAVS2-RAVS) in 90.4% of the cases and significant in all groups (table). In lateralized PA, all expert physicians gave the correct answer in 100% of the cases at day 1. The clinical expertise and PA lateralization were significantly associated with answers. In the correct answers’ category, there was no effect of time on the correct answer but statistically significant effects of clinical expertise and PA lateralization (p < 0.001). Conclusions: The use of a LAVS2 limits the risk on misinterpretation of AVS due to error in the labeling of the sample. As this procedure is easy and cost effective, it could be used in all the centers who do perform AVS. Therefore, based on the HEGP experience, we describe a roadmap for an AVS protocol to ensure a successful procedure