Success Rate Of Adrenal Vein Sampling Research Articles

A clinical assessment of portable point-of-care testing for quick cortisol assay during adrenal vein sampling

This study assessed the clinical performance of point-of-care testing (POCT) for quick cortisol assay (QCA) during adrenal vein sampling (AVS) using a newly invented portable quantitative assay instrument. An observational study was conducted prospectively at two centres in Japan. Forty-eight patients with primary aldosteronism considered for adrenalectomy were enrolled in this study and underwent AVS. Three basal adrenal vein samples from each adrenal vein and two from the inferior vena cava were collected sequentially. The cortisol concentration of adrenal vein samples was measured by routine method and QCA. A total of 338 adrenal vein samples were analysed from 250 sites to determine AVS success or failure. The distribution of turnaround time of the QCA for AVS success or failure followed a normal distribution with an average of 20.5 min. A positive correlation between the routine method and QCA was observed regarding cortisol concentration or selectivity index. No significant difference between the two methods was observed regarding the success rate of AVS. Using the routine method as a reference, the sensitivity and specificity of AVS success or failure were 99.1% (210/212) and 81.6% (31/38), respectively. Easy, quick, portable, and precise POCT-QCA demonstrated its compatibility with routine methods regarding clinical performance.

PS-C21-7: IMPACT OF THE TIME OF DAY PERFORMING AVS ON THE SUCCESS RATE AND SUBTYPE DIAGNOSIS IN PRIMARY ALDOSTERONISM

Purpose: Adrenal vein sampling (AVS) is the gold-standard technique for the subtype diagnosis of primary aldosteronism (PA). Measurements of aldosterone and cortisol in adrenal venous blood are used to determine the success or failure of AVS and to diagnose the PA subtype, but these hormone secretions show diurnal change. In this study, we examined the effect of the time of AVS on the results. Design: Multicenter, retrospective, observational study Setting: Three centers in Japan Patients: 591 patients diagnosed with PA and undergoing AVS at 3 centers were used. All patients underwent basal AVS and ACTH-stimulated AVS on the same day. 382 patients underwent AVS in the morning (AM-AVS) and 209 patients in the afternoon (PM-AVS). Results: In terms of Selectivity Index (SI) in AVS, there was no significant difference in the right adrenal vein in basal AVS (22 vs. 23, p = 0.26), but SI of AM-AVS group was significantly higher in the left adrenal vein (19 vs. 17, p = 0.03). 03) than PM-AVS. However, in AVS after ACTH loading, SIs of both right and left adrenal veins were significantly higher in the PM group (Right: 42 vs. 44, p = 0.03; Left: 48 vs. 50, p = 0.01). However, there was no significant difference in AVS success rates between the two groups for basal AVS (81% vs. 74%, p = 0.08) and ACTH-stimulated AVS (92% vs. 88%, p = 0.19). There was also no significant difference in the proportion of patients diagnosed with unilateral PA in basal AVS (57% vs. 48%, p = 0.09) and ACTH-stimulated AVS (17% vs. 14%, p = 0.41). Conclusions: In a multicenter observational study, there was no significant difference in AVS success rate or subtype diagnosis of AVS between the different AVS times.

The potential application of a three-dimensional visualization technique in adrenal vein sampling

Objective: To explore the potential application of a three-dimensional visualization technique in adrenal vein sampling (AVS). Methods: The clinical data were retrospectively analyzed, which included 76 patients with primary aldosteronism (PA) who have undergone AVS in Guizhou Provincial People's Hospital from December 2017 to May 2020. All cases were examined by adrenal thin-section enhanced CT and blood was drawn by bilateral AVS. Among them, the adrenal vein blood of 46 cases was sampled with the help of three-dimensional (3D) visualization processing of CT data, while that of 30 cases was without 3D visualization processing. The rate of the catheter in place, the successful rate of AVS, the time of blood collection, the dosage of the contrast agent, and surgical complications were compared between the two groups. Results: There were 76 cases included, while 38 were male and 38 were female. The average age was 45 (25-57) years. Compared with the patients without the aid of 3D visualization, the success rate of right AVS of the patients with the aid of 3D visualization technology increased from 43% to 78% (P<0.05). The success rate of adrenal vein blood collection increased from 53% to 83%. The dose of contrast agent decreased [the M(Q1,Q3) were78 (59, 89) ml vs 28 (16, 51) ml, P<0.05], and the time of blood sampling from the right adrenal vein approximately decreased [the M（Q1，Q3） were 70 (66, 88) min vs 44 (22, 61) min, P<0.05]. Compared with the case without the aid of 3D visualization, the left adrenal vein catheterization rate of patients in the 3D visualization group increased from 97% to 98%, the success rate of adrenal vein blood collection increased from 97% to 98%, and the differences of the time of blood sampling and the dosage of the contrast were not statistically significant between the two groups. Among all the cases experienced bilateral AVS, only one patient without 3D reconstruction had contrast extravasation, and the others had no obvious complications. Conclusions: Before AVS, 3D visualization processing of adrenal vein from CT data is capable of increasing the success rate of blood sampling from the right adrenal vein, as well as reducing the dosage of contrast agent and the time of adrenal vein blood sampling. Therefore, it has a potential clinical value of the application.

Impact of cone beam - CT on adrenal vein sampling in primary aldosteronism

PurposeThe aim of this study in a group of patients with primary aldosteronism was to evaluate the contribution of CB-CT (cone beam CT) to the overall success rate of adrenal vein sampling (AVS), and in particular to the selective cannulation of the right adrenal vein (RAV). MethodThis was a retrospective single-center study including 91 AVS procedures performed by our consultant radiologist between March 2011 and January 2017. Fifty cases were performed with CB-CT and 50 were performed without. Angiography with CB-CT was carried out after RAV cannulation to check the accurate catheter position. For each patient, we collected technical and biochemical success rates, as well as irradiation data. ResultsThe overall success rate of AVS with CB-CT was 80 %, vs. 44 % without (p = 0.00046), with right-sided selectivity of 88 % vs. 49 % (p < 0.0001). There was no significant increase in radiation exposure with CB-CT (p = 0.8206). Fluoroscopy time and quantity of iodine injected were significantly lower with CB-CT than without (p = 0.0039 and p < 0.0001). ConclusionCB-CT allows a better evaluation of the selectivity of right-sided adrenal catheterization and greatly increases the overall success rate of AVS.

Impact of New Quick Gold Nanoparticle-Based Cortisol Assay During Adrenal Vein Sampling for Primary Aldosteronism.

Adrenal vein sampling (AVS) is essential for identifying a surgically curable form of primary aldosteronism (PA), but accurate placement of the sampling catheter is technically challenging. Intraprocedural cortisol measurement can confirm the catheter's position, thereby increasing the AVS success rate. We developed a quick cortisol assay (QCA) that uses immunochromatography and gold nanoparticles and can be performed either semiquantitatively or quantitatively. The assay was evaluated in two studies. In a single-center study, PA patients were assigned to undergo AVS incorporating the semiquantitative QCA (n = 30), the quantitative QCA (n = 30), or without the QCA (n = 30), and the rates of successful AVS were determined. In a prospective multicenter randomized, controlled study, the success rates of AVS performed with (n = 148) or without (n = 145) the semiquantitative QCA were determined. Cortisol concentrations were measured during AVS in 6 minutes or less in the radiology suite, without additional technical assistance, and significantly correlated with a conventional reference assay (R(2) = 0.994; P < .001). In the single-center study, the differences in the AVS success rates associated with semiquantitative and quantitative QCAs were not significant (both 93%); however, the success rates were significantly higher than the rate of successful AVS performed without using the QCA (63%; P < .001). The success rate of AVS performed in the multicenter study was 94% for the semiquantitative QCA, which was significantly higher than the rate for the patients without QCA (60%; P < .001). Our novel QCA was rapidly and easily performed at the point of care and improved the rate of successful AVS.

Abstract 19331: The Adrenal Vein Sampling International Study-2: Results in 1636 Primary Aldosteronism Patients

Background: Guidelines recommend Adrenal vein sampling (AVS) for the subtyping of primary aldosteronism (PA), the most common curable cause of arterial hypertension. How this recommendation is implemented in practice remains uncertain. Hence, in 2011 upon completion of the AVIS-1 Study we launched the AVIS-2 Study to determine: 1) the success rate of the AVS studies performed in major referral centers worldwide; 2) the impact of AVS results on the clinical decision making and on outcome of the patients at follow-up. Methods: All the AVIS-1 Study centers were invited to join the AVIS-2 by entering the individual PA patients AVS and clinical data in an ad hoc predefined web-based database. Data were analyzed according to use of cosyntropin unstimulated or -stimulated protocols. Results and Conclusions: Sixteen centers in Europe, North America and Asia recruited a total of 1656 PA patients (age 50 years ± 10; 39.5% females). The AVS success rate was examined as a function of the Selectivity Index (SI) cutoffs. Among unstimulated AVS (n = 1307), the rate of bilaterally selective tests fell from 86% to 53% and 45% with cut off values of 1.10, 2.00 and 3.00, respectively; for adrenalectomized patients (49% of total), the decision was based on bilateral selective AVS in 71%, 56% and 43% of cases, respectively. Among cosyntropin-stimulated AVS, 85%, 80%, 76% and 72% were bilaterally selective, with a cut-off of 2.00, 3.00, 4.00, and 5.00, respectively; the rate of adrenalectomy based on AVS data fell from 47% with a cut-off = 2.00 to 40% with a cut-off = 5.00. The lateralization index value did not improve by comparing those with SI bilaterally &gt; 2.0 (baseline) and &gt; 5.0 after cosyntropin (3.8 [median, 1.6-12.7 IQR] vs 3.7 [1.5-14.0]). Conclusions: Only a minority of PA submitted to AVS have bilaterally selective studies if high cutoffs for the SI are used. Moreover, in even less patients AVS eventually led to adrenalectomy. These intriguing results from the largest dataset of AVS studies provide compelling evidence for the need of further prospective studies in this field.

Implementation of Rapid Cortisol During Adrenal Vein Sampling

We read with great interest the consensus statement on adrenal vein sampling (AVS) by Rossi et al,1 particularly their discussion of rapid cortisol. We recently implemented rapid cortisol during AVS and found it to be a valuable asset in the performance of this essential, but challenging, diagnostic procedure. Before rapid cortisol, our center had a 50% AVS success rate during a 20-month period (n=12) with all the failures because of difficulties cannulating the anatomically challenging right adrenal vein. …

Intraprocedural Cortisol Measurement Increases Adrenal Vein Sampling Success Rate in Primary Aldosteronism

Intraprocedural Cortisol Measurement Increases Adrenal Vein Sampling Success Rate in Primary Aldosteronism

Intraprocedural Cortisol Measurement Increases Adrenal Vein Sampling Success Rate in Primary Aldosteronism

Adrenal venous sampling (AVS) is the gold standard for the identification of unilateral primary aldosteronism (PA), but is technically difficult. The aim of our study was to assess whether intraprocedural cortisol measurement (IPCM) increases AVS success rate. Twenty-five consecutive PA patients underwent cosyntropin-stimulated AVS. Cortisol was measured immediately in a first set of samples drawn from adrenal veins and inferior vena cava. The selectivity criterion was an adrenal vein-to-inferior vena cava cortisol ratio ≥5. If bilateral selectivity was not achieved in a first set of samples, a second set was obtained during the same radiological session. PA was judged as unilateral if the gradient of cortisol-corrected aldosterone between dominant and nondominant side was >3.5. Twenty-five consecutive PA patients who had previously been submitted to AVS without IPCM served as historical controls. Lateralizing patients who underwent unilateral adrenalectomy were followed for 2 years after surgery. Bilateral selectivity using IPCM was achieved in 19/25 patients in the first set of samples, and in an additional four cases in the second set (92% vs. 76%; P = 0.06). The final rate of bilateral selectivity was higher than that obtained in the historical series (23/25 vs. 16/25, P = 0.04), whereas bilateral selectivity in the first set of samples was not different from that achieved in the historical series. Nineteen lateralizing patients (13 of the present series, six of the historical series) were submitted to adrenalectomy, resulting in reversal of PA. IPCM increases the success rate of AVS.