American Association of Endocrine SurgeonsAdrenal venous sampling in primary hyperaldosteronism: Comparison of radiographic with biochemical success and the clinical decision-making with “less than ideal” testing
Section snippets
Material and methods
A retrospective review of all patients referred to an endocrine surgeon or an endocrinologist for evaluation and treatment of PA. The office charts of all patients undergoing AVS were reviewed. Dictated procedure reports from the radiologist performing the venous sampling were graded as “successful” (class 1), “successful but with some technical difficulties” (class 2), or “unsuccessful/modified due to technical difficulties” (class 3). The AVS protocol involved simultaneous bilateral
Results
A total of 60 patients underwent 62 AVS procedures for PA. ACTH stimulation was done in 55 of these AVS. Demographic characteristics of the patients are found in Table I. Dictated radiology reports were available for 61 procedures. Of the procedures, 26 were reported as successful without difficulty, 18 procedures had some technical problems but were ultimately deemed successful, and 17 procedures were difficult requiring modification of the procedure (ie, sampling from outside the orifice of
Discussion
As stated above, AVS is a technologically challenging procedure, especially cannulization of the right adrenal vein. Several large centers report success rates of up to 95% for this procedure.8, 9, 10 However, a recent review of 47 reports that included 384 patients, showed that the overall success rate of AVS in a variety of centers was only 74%.11 In this present series, successful cannulation of both adrenal veins as defined biochemically was achieved in only 21% by pre-ACTH criteria and 42%
References (23)
Diagnosis of hyperaldosteronism
Endocrinol Metab Clin North Am
(1991)- et al.
Role for adrenal venous sampling in primary aldosteronism
Surgery
(2004) - et al.
Primary aldosteronismDiagnostic evaluation
Endocrinol Metab Clin North Am
(1988) - et al.
Long-term treatment of mineralocorticoid excess syndromes
Steroids
(1995) - et al.
Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?
Surgery
(1998) - et al.
Primary aldosteronism: a new clinical entity
Trans Assoc Am Physicians
(1955) Primary aldosteronism
N Engl J Med
(1998)- et al.
Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents
J Clin Endocrinol Metab
(2004) - et al.
High rate of detection of primary aldosteronism, including surgically treatable forms, after ‘non-selective’ screening of hypertensive patients
J Hypertens
(2003) - et al.
Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan
Hypertens Res
(2004)
Primary aldosteronism: computerized tomography in preoperative evaluation
South Med J
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2020, Medicine (Spain)Primary Aldosteronism: Diagnosis and Management
2016, American Journal of the Medical SciencesCitation Excerpt :The concern with AVS is that it is an invasive and technically demanding test that requires skilled radiologists for successful cannulation of both adrenal veins. The technical success rate of AVS judged by biochemical criteria occurs in only 44% of attempts40 with a complication rate as high as 2.5%,33 even in experienced hands. Despite Endocrine Society recommendations, several groups advocate for the selective use of AVS.
SFE/SFHTA/AFCE consensus on primary aldosteronism, part 4: Subtype diagnosis
2016, Annales d'EndocrinologieA coaxial guide wire-catheter technique to facilitate right adrenal vein sampling: Evaluation in 76 patients
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