Endocrinol Metab.  2018 Jun;33(2):236-244. 10.3803/EnM.2018.33.2.236.

C-Arm Computed Tomography-Assisted Adrenal Venous Sampling Improved Right Adrenal Vein Cannulation and Sampling Quality in Primary Aldosteronism

• Park CH
• Hong N
• Han K
• Kang SW
• Lee CR
• Park S
• Rhee Y

• KMID: 2420492
• DOI: http://doi.org/10.3803/EnM.2018.33.2.236

Abstract

BACKGROUND
Adrenal venous sampling (AVS) is a gold standard for subtype classification of primary aldosteronism (PA). However, this procedure has a high failure rate because of the anatomical difficulties in accessing the right adrenal vein. We investigated whether C-arm computed tomography-assisted AVS (C-AVS) could improve the success rate of adrenal sampling.
METHODS
A total of 156 patients, diagnosed with PA who underwent AVS from May 2004 through April 2017, were included. Based on the medical records, we retrospectively compared the overall, left, and right catheterization success rates of adrenal veins during the periods without C-AVS (2004 to 2010, n=32) and with C-AVS (2011 to 2016, n=124). The primary outcome was adequate bilateral sampling defined as a selectivity index (SI) >5.
RESULTS
With C-AVS, the rates of adequate bilateral AVS increased from 40.6% to 88.7% (P<0.001), with substantial decreases in failure rates (43.7% to 0.8%, P<0.001). There were significant increases in adequate sampling rates from right (43.7% to 91.9%, P<0.001) and left adrenal veins (53.1% to 95.9%, P<0.001) as well as decreases in catheterization failure from right adrenal vein (9.3% to 0.0%, P<0.001). Net improvement of SI on right side remained significant after adjustment for left side (adjusted SI, 1.1 to 9.0; P=0.038). C-AVS was an independent predictor of adequate bilateral sampling in the multivariate model (odds ratio, 9.01; P<0.001).
CONCLUSION
C-AVS improved the overall success rate of AVS, possibly as a result of better catheterization of right adrenal vein.

Keyword

Hyperaldosteronism; Hypertension; Cone-beam computed tomography; Adrenalectomy

MeSH Terms

Adrenalectomy
Catheterization*
Catheters
Classification
Cone-Beam Computed Tomography
Humans
Hyperaldosteronism*
Hypertension
Medical Records
Retrospective Studies
Veins*

Figure

• 

  Fig. 1 Flowcharts of the study subjects in (A) pre- and (B) post-C-arm CT-assisted AVS (C-AVS) era. ARR, aldosterone-to-renin ratio; PAC, plasma aldosterone concentration; SIT, saline infusion test; AVS, adrenal venous sampling; PA, primary aldosteronism; CT, computed tomography.

• 

  Fig. 2 Comparison of (A) the rates of adequate bilateral adrenal venous sampling (AVS) and (B) selectivity indices in pre- and post-C-arm computed tomography-assisted AVS (C-AVS) era. Adjusted right side selectivity index (SI) was calculated by subtracting left SI from right SI. The middle line of the box indicates the median. The lower and the upper end of the whiskers indicate the minimum and the maximum observations blow the upper fence (1.5 interquartile range above the 75th percentile), respectively. aAdequate bilateral indicates adequate sampling in both sides; bAdequate unilateral indicates adequate sampling in any one side with catheterization failure or inadequate sampling on the other side; cFailure indicates catheterization failure or inadequate sampling on both sides.

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