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Simultaneous bilateral adrenal vein sampling for primary aldosteronism: useful tips to make it simple and safe

  • Vascular-Interventional
  • Published:
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Abstract

Adrenal vein sampling (AVS) is the key test for subtyping patients with primary aldosteronism (PA) before referring those with unilateral disease for laparoscopic unilateral adrenalectomy. However, it is still not systematically used, despite guidelines recommendations, because it is still considered as an invasive, risky, and challenging procedure. Simultaneous bilateral catheterization is believed to add technical difficulties inherent with attempting to catheterize both adrenal veins at the same time, but can be useful to minimize differences between the sides due to timing. We herein report on the protocol for routine clinical use. Tips for preparation of the patient as well as optimal catheterization of adrenal veins and sampling are provided to propose a protocol that is easy, safe, and reliable.

Key Points

• Adrenal vein sampling is the reference standard in the case of primary aldosteronism to detect the hyper-functioning side and allow subsequent treatment.

• Simultaneous bilateral adrenal vein sampling avoids bias related to sampling timing.

• Some technical suggestions concerning patient preparation and catheterization are proposed to make simultaneous adrenal vein sampling easier and safer

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Abbreviations

ACTH:

Adrenocorticotropic hormone

APA:

Aldosterone-producing adenoma

AVS:

Adrenal vein sampling

PA:

Primary aldosteronism

PCC:

Plasma cortisol concentration

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Institute of Radiology, Department of Medicine – DIMED, University Hospital of Padova, via Giustiniani 2, 35128, Padua, Italy

    Amalia Lupi, Michele Battistel, Giulio Barbiero, Diego Miotto & Emilio Quaia

  2. Hypertension Clinic, Department of Medicine – DIMED, University Hospital of Padova, Padua, Italy

    Gian Paolo Rossi

Authors
  1. Amalia Lupi
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  2. Michele Battistel
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  3. Giulio Barbiero
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  4. Diego Miotto
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  5. Gian Paolo Rossi
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  6. Emilio Quaia
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Corresponding author

Correspondence to Amalia Lupi.

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Guarantor

The scientific guarantor of this publication is Prof. Emilio Quaia.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because it concerns the development of a technique perfected over the years with the experience gained in our center; therefore, it is not focused on a patient population. However, all patients who are sent to our facility to undergo the procedure expressed their written consent to that.

Ethical approval

Institutional Review Board approval was not required because this work describes our protocol to perform AVS procedure.

Methodology

• Performed at one institution

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Lupi, A., Battistel, M., Barbiero, G. et al. Simultaneous bilateral adrenal vein sampling for primary aldosteronism: useful tips to make it simple and safe. Eur Radiol 29, 6330–6335 (2019). https://doi.org/10.1007/s00330-019-06209-5

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  • DOI: https://doi.org/10.1007/s00330-019-06209-5

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