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Abstract

Objectives:

Adrenal vein sampling (AVS) is an established procedure for assessing subtype patients with primary aldosteronism (PA). However, it is technically challenging, with high failure rates, which limits its application in clinical practice. Our study aimed to evaluate the safety and efficacy of a single-catheter modified approach for AVS.

Methods:

The clinical, angiographic, and procedural data of 182 consecutive patients who underwent AVS procedures between May 2020 and May 2023 were collected and analyzed. The single-catheter modified approach was performed as a single 5 F Tiger catheter with only one-time manual reshaping, which was recommended for sequential bilateral adrenal cannulations.

Results:

Of the 182 consecutive patients, 174 (95.6%) had successful bilateral adrenal cannulation. The single-catheter modified approach was successfully performed to cannulate the right adrenal vein in 176 (96.7%) patients, while another six (3.3%) patients needed at least a second manual reshaping for 5 F Tiger catheters. For left adrenal cannulation, a single-catheter modified approach was successfully used in 179 (98.4%) patients, whereas 5 F Tiger catheters with at least second-time manual reshaping were used in the remaining three (1.6%) patients. The procedural period was 15.6 ± 10.8 min, the fluoroscopy time was 4.2 ± 1.5 min, and the diagnostic contrast was 15.5 ± 4.8 mL. The incidence of procedure-related complications associated with AVS was 1.1%. The cumulative summation assessment illustrated that the learning curve for the operating procedure required up to 29 cases, indicating that the procedure time was shortened after 29 cases.

Conclusions:

The single-catheter modified approach is an effective, safe, and feasible technique for AVS treatment. In particular, this improved method is not difficult for beginners with high technical success rates.

Keywords

Adrenal venous sampling hyperaldosteronism Tiger catheter safety efficacy

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References

Turcu

Yang

Vaidya

Primary aldosteronism—a multidimensional syndrome. Nat Rev Endocrinol 2022; 18(11): 665–682.

Monticone

Burrello

Tizzani

, et al. Prevalence and clinical manifestations of primary aldosteronism encountered in primary care practice. J Am Coll Cardiol 2017; 69(14): 1811–1820.

Yang

, et al. Primary aldosteronism in patients in china with recently detected hypertension. J Am Coll Cardiol 2020; 75(16): 1913–1922.

Zhu

Heizhati

Lin

, et al. Higher plasma aldosterone concentrations are associated with elevated risk of aortic dissection and aneurysm: a case-control study. Hypertension 2022; 79(4): 736–746.

Hundemer

Curhan

Yozamp

, et al. Cardiometabolic outcomes and mortality in medically treated primary aldosteronism: a retrospective cohort study. Lancet Diabetes Endocrinol 2018; 6(1): 51–59.

Ogata

Yamazaki

Tezuka

, et al. Renal injuries in primary aldosteronism: quantitative histopathological analysis of 19 patients with primary adosteronism. Hypertension 2021; 78(2): 411–421.

Alam

Kandasamy

Goyal

, et al. High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension. Clin Endocrinol 2021; 94(6): 895–903.

Lee

Yano

Cho

SMJ

, et al. Adherence to antihypertensive medication and incident cardiovascular events in young adults with hypertension. Hypertension 2021; 77(4): 1341–1349.

Zennaro

Boulkroun

Fernandes-Rosa

FL.

Pathogenesis and treatment of primary aldosteronism. Nat Rev Endocrinol 2020; 16(10): 578–589.

10.

Reincke

Bancos

Mulatero

, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol 2021; 9(12): 876–892.

11.

Monticone

Viola

Rossato

, et al. Adrenal vein sampling in primary aldosteronism: towards a standardised protocol. Lancet Diabetes Endocrinol 2015; 3(4): 296–303.

12.

Thiesmeyer

Ullmann

Stamatiou

, et al. Association of adrenal venous sampling with outcomes in primary aldosteronism for unilateral adenomas. JAMA Surg 2021; 156(2): 165–171.

13.

Rossi

Auchus

Brown

, et al. An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension 2014; 63(1): 151–160.

14.

Wolley

Thuzar

Stowasser

Controversies and advances in adrenal venous sampling in the diagnostic workup of primary aldosteronism. Best Pract Res Clin Endocrinol Metab 2020; 34(3): 101400.

15.

Omura

Ota

Takahashi

, et al. Anatomical variations of the right adrenal vein: concordance between multidetector computed tomography and catheter venography. Hypertension 2017; 69(3): 428–434.

16.

Sato

Shirota

Makita

, et al. Anatomical variations of the left adrenal vein encountered during venous sampling. J Vasc Interv Radiol 2022; 33(1): 71–77.e3.

17.

Loberg

Antoch

Stegbauer

, et al. Update: selective adrenal venous sampling (AVS) - indication, technique, and significance. Rofo 2021; 193(6): 658–666.

18.

Yozamp

Hundemer

Moussa

, et al. Adrenocorticotropic hormone-stimulated adrenal venous sampling underestimates surgically curable primary aldosteronism: a retrospective cohort study and review of contemporary studies. Hypertension 2021; 78(1): 94–103.

19.

Almarzooqi

Chagnon

Soulez

, et al. Adrenal vein sampling in primary aldosteronism: concordance of simultaneous vs sequential sampling. Eur J Endocrinol 2017; 176(2): 159–167.

20.

Rossi

GP.

Primary aldosteronism: JACC state-of-the-art review. J Am Coll Cardiol 2019; 74(22): 2799–2811.

21.

Zhu

Gong

Zhu

, et al. Assessing ultrasound-guided axillary vein cannulation using a cumulative sum analysis: a single operator experience. J Vasc Access 2023; 24(3): 436–442.

22.

Wan

Ran

Xia

, et al. Feasibility and effectiveness of a single-catheter approach for adrenal vein sampling in patients with primary aldosteronism. BMC Endocr Disord 2021; 21(1): 22–28.

23.

Rossi

Rossitto

Amar

, et al. Clinical outcomes of 1625 patients with primary aldosteronism subtyped with adrenal vein sampling. Hypertension 2019; 74(4): 800–808.

24.

Jiang

Dong

Peng

, et al. A novel method of adrenal venous sampling via an antecubital approach. Cardiovasc Intervent Radiol 2017; 40(3): 388–393.

25.

Noda

Goshima

Nagata

, et al. Utility of microcatheter in adrenal venous sampling for primary aldosteronism. Br J Radiol 2020; 93(1109): 20190636.

26.

Xanthopoulou

Stavrou

Davlouros

, et al. Randomised comparison of JUDkins vs. tiGEr catheter in coronary angiography via the right radial artery: the JUDGE study. EuroIntervention 2018; 13(16): 1950–1958.

27.

Zhang

, et al. The investigation of adrenal vein sampling technique. J Intervent Radiol 2011; 20(6): 436–439.

28.

Dong

Jiang

Peng

, et al. The safety and feasibility study of adrenal vein sampling via median cubital vein: the first report of 50 cases. Chin J Hypertens 2016; 24(2): 158–162.

29.

Lin

Zhang

, et al. The effect of improved operation procedure of sequential adrenal vein sampling via median cubital vein. Chin J Hypertens 2020; 28(6): 539–543.

30.

Liu

Song

, et al. Computed tomography image fusion, coaxial guidewire technique, fast intraprocedural cortisol testing technique improves success rate and decreases radiation exposure, procedure time, and contrast use for adrenal vein sampling. J Hypertens 2021; 39(9): 1918–1925.

31.

DePietro

Trerotola

SO.

Techniques in adrenal vein sampling: multipurpose catheter shape facilitates sampling of cranially oriented right adrenal veins. Diagn Interv Radiol 2022; 28(1): 79–82.

32.

Lee

Chang

Liu

, et al. Evaluation of right adrenal vein anatomy by Dyna computed tomography in patients with primary aldosteronism. Sci Rep 2016; 6: 28305.

33.

Qian

Yang

, et al. Use the right kidney contour as a landmark in adrenal vein sampling. PLoS One 2022; 17(9): e0263945.

34.

Fan

Jian

Impact of diagnosis-related-group (DRG) payment on variation in hospitalization expenditure: evidence from China. BMC Health Serv Res 2023; 23(1): 688–697.

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A modified single-catheter approach for improving adrenal venous sampling in patients with primary aldosteronism

Abstract

Objectives:

Methods:

Results:

Conclusions:

Keywords

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References

Supplementary Material