Skip to main content
SpringerLink
Log in

Advantages of Intraprocedural Unenhanced CT During Adrenal Venous Sampling to Confirm Accurate Catheterization of the Right Adrenal Vein

  • Clinical Investigation
  • Venous Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the advantages of intraprocedural CT during adrenal venous sampling (AVS) to confirm accurate catheterization of the right adrenal vein (RAV).

Materials and Methods

This single-institution study included 106 patients (mean age 52.4 years; range 28–74 years) with primary aldosteronism who performed contrast-enhanced CT (CECT) before AVS following AVS between January 2011 and March 2018. After catheterization of the RAV under fluoroscopic guidance, unenhanced CT images were obtained to confirm catheter position on unified CT angiography system. Catheter repositioning was performed when the catheter was inaccurately positioned. Venography findings were classified into two groups: (1) presumably cannulated in the RAV (presumed RAV group) and (2) obscured visualization of the RAV because of collateral vessels (obscured RAV group). Success rates of AVS were compared using Fisher’s exact test.

Results

The overall success of AVS was achieved in 104 patients (98.1%). Catheter was deviated into the IVC during intraprocedural CT in four patients. Fourteen patients (14.0%) required catheter repositioning by intraprocedural CT images, and accurate catheterization in the RAV was eventually accomplished. The success rate of AVS was significantly higher in the presumed RAV group (90.1% [73/81]) than that in the obscured RAV group (68.4% [13/19]) (p = 0.024). If intraprocedural CT was not acquired during AVS, the success rate of AVS would have been significantly lower (84.9% [90/106]) compared with that use of intraprocedural CT (98.1% [104/106]) (p < 0.001).

Conclusions

Intraprocedural unenhanced CT by referring to the preprocedural CECT before AVS enables the confirmation of accurate catheterization of the RAV.

Level of Evidence

Level 4, case series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Rossi GP, Bernini G, Caliumi C, et al. A prospective study of the prevalence of primary aldosteronism in 1,125 hypertensive patients. J Am Coll Cardiol. 2006;48:2293–300.

    Article  PubMed  CAS  Google Scholar 

  2. Douma S, Petidis K, Doumas M, et al. Prevalence of primary hyperaldosteronism in resistant hypertension: a retrospective observational study. Lancet. 2008;371:1921–6.

    Article  PubMed  CAS  Google Scholar 

  3. Savard S, Amar L, Plouin PF, Steichen O. Cardiovascular complications associated with primary aldosteronism: a controlled cross-sectional study. Hypertension. 2013;62:331–6.

    Article  PubMed  CAS  Google Scholar 

  4. Mulatero P, Monticone S, Bertello C, et al. Long-term cardio- and cerebrovascular events in patients with primary aldosteronism. J Clin Endocrinol Metab. 2013;98:4826–33.

    Article  PubMed  CAS  Google Scholar 

  5. Kempers MJ, Lenders JW, van Outheusden L, et al. Systematic review: diagnostic procedures to differentiate unilateral from bilateral adrenal abnormality in primary aldosteronism. Ann Intern Med. 2009;151:329–37.

    Article  PubMed  Google Scholar 

  6. Nishikawa T, Omura M, Satoh F, et al. Guidelines for the diagnosis and treatment of primary aldosteronism—the Japan Endocrine Society 2009. Endocr J. 2011;58:711–21.

    Article  PubMed  CAS  Google Scholar 

  7. Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment—an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101:1889–916.

    Article  PubMed  CAS  Google Scholar 

  8. Daunt N. Adrenal vein sampling: how to make it quick, easy, and successful. Radiographics. 2005;25(Suppl 1):S143–58.

    Article  PubMed  Google Scholar 

  9. Omura K, Ota H, Takahashi Y, et al. Anatomical variations of the right adrenal vein: concordance between multidetector computed tomography and catheter venography. Hypertension. 2017;69:428–34.

    Article  PubMed  CAS  Google Scholar 

  10. Morita S, Nishina Y, Yamazaki H, Sonoyama Y, Ichihara A, Sakai S. Dual adrenal venous phase contrast-enhanced MDCT for visualization of right adrenal veins in patients with primary aldosteronism. Eur Radiol. 2016;26:2073–7.

    Article  PubMed  Google Scholar 

  11. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery. 2004;136:1227–35.

    Article  PubMed  Google Scholar 

  12. Satoh F, Abe T, Tanemoto M, et al. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res. 2007;30:1083–95.

    Article  PubMed  CAS  Google Scholar 

  13. Park SI, Rhee Y, Lim JS, et al. Right adrenal venography findings correlated with C-arm CT for selection during C-arm CT-assisted adrenal vein sampling in primary aldosteronism. Cardiovasc Interv Radiol. 2014;37:1469–75.

    Article  Google Scholar 

  14. Onozawa S, Murata S, Tajima H, et al. Evaluation of right adrenal vein cannulation by computed tomography angiography in 140 consecutive patients undergoing adrenal venous sampling. Eur J Endocrinol. 2014;170:601–8.

    Article  PubMed  CAS  Google Scholar 

  15. Chang CC, Lee BC, Chang YC, Wu VC, Huang KH, Liu KL. Comparison of C-arm computed tomography and on-site quick cortisol assay for adrenal venous sampling: a retrospective study of 178 patients. Eur Radiol. 2017;27:5006–14.

    Article  PubMed  Google Scholar 

  16. Auchus RJ, Michaelis C, Wians FHJ, et al. Rapid cortisol assays improve the success rate of adrenal vein sampling for primary aldosteronism. Ann Surg. 2009;249:318–21.

    Article  PubMed  Google Scholar 

  17. Reardon MA, Angle JF, Abi-Jaoudeh N, et al. Intraprocedural cortisol levels in the evaluation of proper catheter placement in adrenal venous sampling. J Vasc Interv Radiol. 2011;22:1575–80.

    Article  PubMed  Google Scholar 

  18. Tanaka T, Arai Y, Inaba Y, et al. Current role of hybrid CT/angiography system compared with C-arm cone beam CT for interventional oncology. Br J Radiol. 2014;87:20140126.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Bai M, Liu B, Mu H, Liu X, Jiang Y. The comparison of radiation dose between C-arm flat-detector CT (DynaCT) and multi-slice CT (MSCT): a phantom study. Eur J Radiol. 2012;81:3577–80.

    Article  PubMed  Google Scholar 

  20. Loffroy R, Lin M, Rao P, et al. Comparing the detectability of hepatocellular carcinoma by C-arm dual-phase cone-beam computed tomography during hepatic arteriography with conventional contrast-enhanced magnetic resonance imaging. Cardiovasc Intervent Radiol. 2012;35:97–104.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Koji Maruyama, Keitaro Sofue, Takuya Okada, Yutaka Koide, Eisuke Ueshima, Ryuichiro Tani, Tomoyuki Gentsu, Hiroki Horinouchi, Koji Sasaki, Masato Yamaguchi, Koji Sugimoto & Takamichi Murakami

  2. Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Hyogo, Japan

    Genzo Iguchi

Authors
  1. Koji Maruyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keitaro Sofue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takuya Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yutaka Koide
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eisuke Ueshima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Genzo Iguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryuichiro Tani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomoyuki Gentsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroki Horinouchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koji Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masato Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Koji Sugimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Takamichi Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keitaro Sofue.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This retrospective study design was approved by our institutional review board. For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maruyama, K., Sofue, K., Okada, T. et al. Advantages of Intraprocedural Unenhanced CT During Adrenal Venous Sampling to Confirm Accurate Catheterization of the Right Adrenal Vein. Cardiovasc Intervent Radiol 42, 542–551 (2019). https://doi.org/10.1007/s00270-018-2135-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-018-2135-5

Keywords

Search

Navigation