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Adrenal venous sampling: The learning curve of a single interventionalist with 282 consecutive procedures

Journal article
Authors Hugo Jakobsson
Katerina Farmaki
Augustinas Sakinis
Olof Ehn
Gudmundur Johannsson
Oskar Ragnarsson
Published in Diagnostic and Interventional Radiology
Volume 24
Issue 2
Pages 89-93
ISSN 1305-3825
Publication year 2018
Published at Institute of Medicine
Pages 89-93
Language en
Keywords aldosterone, hydrocortisone, adrenal venous sampling, adult, aged, Article, female, human, hypertension, inferior cava vein, left suprarenal vein, major clinical study, male, medical procedures, peripheral vein, primary hyperaldosteronism, retrospective study, right suprarenal vein
Subject categories Radiology


PURPOSE Primary aldosteronism (PA) is a common cause of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for assessing laterality of PA, which is of paramount importance to decide adequate treatment. AVS is a technically complicated procedure with success rates ranging between 30% and 96%. The aim of this study was to investigate the success rate of AVS over time, performed by a single interventionalist. METHODS This was a retrospective study based on consecutive AVS procedures performed by a single operator between September 2005 and June 2016. Data on serum concentrations of aldosterone and cortisol from right and left adrenal vein, inferior vena cava, and peripheral vein were collected and selectivity index (SI) calculated. Successful AVS was defined as SI >5. RESULTS In total, 282 AVS procedures were performed on 269 patients, 168 men (62%) and 101 women (38%), with a mean age of 55±11 years (range, 26–78 years). Out of 282 AVS procedures, 259 were successful, giving an overall success rate of 92%. The most common reason for failure was inability to localize the right adrenal vein (n=16; 76%). The success rates were 63%, 82%, and 94% during the first, second, and third years, respectively. During the last 8 years the success rate was 95%, and on average 27 procedures were performed annually. CONCLUSION Satisfactory AVS success rate was achieved after approximately 36 procedures and satisfactory success rate was maintained by performing approximately 27 procedures annually. AVS should be limited to few operators that perform sufficiently large number of procedures to achieve, and maintain, satisfactory AVS success rate. © Turkish Society of Radiology 2018.

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