The Inferior Accessory Hepatic Vein: An Anatomic Landmark in Adrenal Vein Sampling

Abstract

Purpose To evaluate the use of the inferior accessory hepatic vein (IAHV) as an anatomic marker for the right adrenal vein (RAV) for adrenal vein sampling (AVS) and the use of a renal double curve (RDC) catheter to sample the RAV. Materials and Methods In 73 patients undergoing AVS, an RDC catheter was first directed laterally and withdrawn from the hepatic vein confluence inferiorly. If the catheter engaged the IAHV, this location was documented. A search for the RAV was conducted using the standard technique. If the IAHV was present, its distance from the RAV was measured. Alternate catheters and ultimately successful shape were recorded. A sequential poststimulation technique was used in all patients. Results The IAHV was found in 42 of 73 patients (58%). The mean RAV to IAHV distance was 4.4 mm ± 4.7 (range 0–20 mm); it was 5 mm or less in 30 of 42 patients (71%) with an IAHV or 30 of 73 (41%) patients overall. In patients with an IAHV, RAV sampling was successful in 40 of 42 (95%). In 61 of 73 patients (84%), the RDC catheter was successful in localizing the RAV. In those patients, the RAV sample was adequate in 60 of 61 (98%) versus 9 of 12 (75%) in the remainder ( P = .013). Overall, AVS was technically successful in 67 of 73 patients (92%). Conclusions The IAHV, when present, may help localize the RAV; this knowledge could help increase diagnostic yield for less experienced operators. The RDC catheter has a high yield in RAV sampling.