open access

Vol 75, No 1 (2017)
Original articles
Published online: 2016-11-17
Submitted: 2016-07-12
Accepted: 2016-10-06
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A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

Jacek Kądziela, Aleksander Prejbisz, Ilona Michałowska, Sylwia Kołodziejczyk-Kruk, Leo Schultze Kool, Marek Kabat, Hanna Janaszek-Sitkowska, Sadegh Toutounchi, Zbigniew Gałązka, Urszula Ambroziak, Tomasz Bednarczuk, Dorota Ptasińska-Wnuk, Michał Hoffmann, Magdalena Januszewicz, Andrzej Januszewicz, Adam Witkowski
DOI: 10.5603/KP.a2016.0166
·
Pubmed: 27878800
·
Kardiol Pol 2017;75(1):28-34.

open access

Vol 75, No 1 (2017)
Original articles
Published online: 2016-11-17
Submitted: 2016-07-12
Accepted: 2016-10-06

Abstract

Background: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a “gold standard” procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease.

Aim: The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure.

Methods: All patients had primary aldosteronism confirmed in a salt-infusion test. AVS was performed sequentially during a continuous intravenous infusion of cosyntropin and was preceded by multislice contrast-enhanced computed tomography (CT) examination of adrenal glands performed a few weeks before AVS in the majority of patients. AVS was regarded as successful if the ratio of each adrenal vein cortisol to inferior vena cava cortisol levels (selectivity index [SI]) was higher than 3.0. In the case of failure, a second attempt was considered in a few weeks. Patients were divided into four groups according to the order of the procedure by quartiles.

Results: Between 31 May, 2012 and 5 May, 2016, AVS was performed in 124 patients (69% males, aged 55.3 ± 10.3 years) and was successful in 120 (96.8%) patients. All failed cases were due to the failure of cannulation of the right adrenal vein. The first-attempt success rate was 94.3% (117 of 124 patients) and increased from 83.9% in the first 31 patients to 100% in the last 31 patients. Similarly, the overall success rate increased from 93.5% to 100%. The right SI was significantly higher than the left one (26.4 vs. 11.0, p < 0.0001). Both indices did not differ across quartiles of patients. No complications occurred during the procedure.

Conclusions: The AVS procedure, preceded by adrenal CT, may be implemented into daily diagnostic practice safely with an excellent success rate.

Abstract

Background: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a “gold standard” procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease.

Aim: The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure.

Methods: All patients had primary aldosteronism confirmed in a salt-infusion test. AVS was performed sequentially during a continuous intravenous infusion of cosyntropin and was preceded by multislice contrast-enhanced computed tomography (CT) examination of adrenal glands performed a few weeks before AVS in the majority of patients. AVS was regarded as successful if the ratio of each adrenal vein cortisol to inferior vena cava cortisol levels (selectivity index [SI]) was higher than 3.0. In the case of failure, a second attempt was considered in a few weeks. Patients were divided into four groups according to the order of the procedure by quartiles.

Results: Between 31 May, 2012 and 5 May, 2016, AVS was performed in 124 patients (69% males, aged 55.3 ± 10.3 years) and was successful in 120 (96.8%) patients. All failed cases were due to the failure of cannulation of the right adrenal vein. The first-attempt success rate was 94.3% (117 of 124 patients) and increased from 83.9% in the first 31 patients to 100% in the last 31 patients. Similarly, the overall success rate increased from 93.5% to 100%. The right SI was significantly higher than the left one (26.4 vs. 11.0, p < 0.0001). Both indices did not differ across quartiles of patients. No complications occurred during the procedure.

Conclusions: The AVS procedure, preceded by adrenal CT, may be implemented into daily diagnostic practice safely with an excellent success rate.

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Keywords

adrenal vein sampling, primary aldosteronism, secondary hypertension

About this article
Title

A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 1 (2017)

Pages

28-34

Published online

2016-11-17

DOI

10.5603/KP.a2016.0166

Pubmed

27878800

Bibliographic record

Kardiol Pol 2017;75(1):28-34.

Keywords

adrenal vein sampling
primary aldosteronism
secondary hypertension

Authors

Jacek Kądziela
Aleksander Prejbisz
Ilona Michałowska
Sylwia Kołodziejczyk-Kruk
Leo Schultze Kool
Marek Kabat
Hanna Janaszek-Sitkowska
Sadegh Toutounchi
Zbigniew Gałązka
Urszula Ambroziak
Tomasz Bednarczuk
Dorota Ptasińska-Wnuk
Michał Hoffmann
Magdalena Januszewicz
Andrzej Januszewicz
Adam Witkowski

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