Journal of Vascular and Interventional Radiology
Comparison of Sequential versus Simultaneous Methods of Adrenal Venous Sampling
Section snippets
MATERIALS AND METHODS
The institutional review board granted exemption for retrospective study of patients referred to the division of interventional radiology at our institution for adrenal venous sampling between July 2001 and May 2003. Two interventional radiologists (C.C., S.O.T.), both with more than 10 years of experience with AVS, each performed 11 AVS procedures, for a total of 22 procedures. Twenty-one patients, 13 men and eight women with a mean age of 50 years (range, 40–68 years), were included in the
RESULTS
Clinical data are shown in Table 1 (online only, see www.jvir.org). Preprocedural adrenal CT/MR imaging revealed unilateral lesions in 19 of 21 patients (90%). AVS results were concordant in 12 of 19 cases (63%) and discordant in seven of 19 cases (37%) with unilateral findings on CT/MR imaging. AVS demonstrated bilateral disease in five of seven discordant cases (71%), whereas the remaining two (29%) had adrenal disease that lateralized to the side opposite that predicted by CT/MR imaging.
DISCUSSION
Primary hyperaldosteronism, first described by Conn (15), contributes to hypertension in an estimated 1%–13% of patients in clinical practice (1, 2). Although hyperaldosteronism afflicts a minority of patients with hypertension, unlike other causes of essential or secondary hypertension, the condition is potentially curable by surgical excision of the abnormal adrenal gland. A spectrum of structural and functional abnormalities produce hyperaldosteronism (4, 8, 13). The most common morphologies
CONCLUSION
This study presents sequential bilateral catheterization as an accurate and economical alternative to the twocatheter technique of AVS for preoperative localization and judicious clinical management of primary hyperaldosteronism. Our results do not support the use of prestimulation samples because they do not affect management and may in fact confound the diagnosis.
Acknowledgments
The authors thank Medcomp for a grant that supported this project, Lori Deslandes for her secretarial support, and Myron Weinberger, MD, for his insight into adrenal venous sampling and hyperaldosteronism.
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Supported in part by a grant from MedComp, Harleysvile, PA.
From the 2004 SIR Annual Meeting.