THU597 Po2-guided Adrenal Vein Sampling In Primary Aldosteronism

Abstract

Abstract Disclosure: K. Omata: None. Y. Tezuka: None. Y. Ono: None. F. Satoh: None. Background: Accurate laterality diagnosis of adrenal aldosterone over-secretion is crucial in determining specific treatment for primary aldosteronism. Although adrenal vein sampling (AVS) is considered as the gold standard method for lateralization, successful canulation to right adrenal vein (RAV) has been reported to be difficult since RAV usually empties directly into inferior vena cava (IVC). In addition, the entrance of RAV is close to that of hepatic vein (HV) or opens to a common trunk with HV in up to 20% of the patients with PA. Cortisol step-up and other proposed indices are not always available during the procedure. Method: AVS was performed in confirmed PA patients between January 2021 and March 2022 at Tohoku University Hospital. During AVS, a small portion (0.3mL) of the sampled veins (RAV, IVC and HV) were analyzed with a blood gas analyzer for partial pressure of oxygen (pO2) measurement. Result: A total of 113 AVS was performed. After excluding inappropriate samples, further analyzed were 113 samples of IVC, 100 of RAV, 109 of HV before cosyntropin stimulation, and 113 samples of IVC, 110 of RAV, 108 of HV after cosyntropin stimulation. We observed an average of 22 mmHg increase of pO2 in RAV than IPV, and 27 mmHg increase than HV before stimulation. The difference between RAV and IPV was 15 mmHg in average and that of RAV and HV was 21 mmHg after stimulation. Similar pO2 step-up was also observed between left adrenal vein and left inferior phrenic vein. Discussion: Here we first describe prominent pO2 step-up in both adrenal veins compared to neighboring non-adrenal veins and peripheral blood. pO2 measurement is easier, faster, less expensive, and requires a very small amount of sample, can be performed by routine equipments in angiography suite, compared to other selectivity indices of successful canulation in AVS. This could also contribute to reducing unnecessary blood sampling, radiation exposure and repeat AVS. pO2 step-up in adrenal vein suggests low oxygen consumption in adrenal glands, which potentially contributes to survival advantage in systemic hypoxic conditions. We propose the novel pO2-guided AVS especially in patients with difficult RAV anatomy and in unexperienced centers. Presentation: Thursday, June 15, 2023