Professional Documents
Culture Documents
Quick
Summary
BOTTOM
LINE
Although
higher
levels
of
cortisol
and
aldosterone
were
obtained
upstream,
A/C
ratio
was
not
signi?icantly
different
between
the
central
adrenal
vein
and
the
common
trunk.
MAJOR POINTS
The rate of primary aldosteronism among patients with hypertension is between 3% and 9%.
The
absolute
differences
in
cortisol
and
aldosterone
between
the
central
adrenal
vein
and
common
trunk
found
in
this
study
are
though
to
have
resulted
from
dilutional
effect
by
the
ef?luence
of
the
inferior
phrenic
nerve.
CRITICISM
Only
1
sample
was
taken
in
each
adrenal
vein,
which
fails
to
account
for
variants
in
venous
anatomy
and
lack
of
reproducibility
of
the
study
due
to
variable
positioning
of
the
catheter
tip.
A
low
selectivity
index
of
greater
than
1.1
was
employed,
though
an
index
>2
or
3
would
have
been
more
accurate
Study
design
Retrospective
data
collection
and
analysis
INCLUSION CRITERIA
Patients
underwent
an
enhanced
CT
scan
to
detect
the
adrenal
veins
and
screen
the
adrenal
glands.
EXCLUSION
CRITERIA
Purpose
To
compare
left
adrenal
venous
sampling
in
two
locations:
the
central
adrenal
vein
and
the
common
trunk.
The
study
was
designed
to
examine
the
effect
on
adrenal
vein
sampling
of
the
dilution
caused
by
the
in?low
of
the
left
inferior
phrenic
vein.
Interven7on
A 5-F sheath was inserted through the percutaneous femoral vein approach
Blood was ?irst obtained from the IVC below the con?luence of the renal veins
A
catheter
was
inserted
into
the
left
adrenal
vein
and
venography
was
performed
to
con?irm
the
con?luence
of
the
central
adrenal
vein
and
the
left
inferior
phrenic
vein.
A
microcatheter
was
inserted
beyond
the
con?luence
of
the
inferior
phrenic
vein
to
reach
the
central
adrenal
vein
followed
by
venography
to
con?irm
location
before
a
sample
was
taken.
Next, a catheter was inserted into the right adrenal vein followed by venography and blood collection.
One
sample
was
obtained
from
each
vein
in
one
AVS
procedure,
and
blood
was
aspirated
by
gentle
slow
suction
to
avoid
adrenal
venous
dilution.
Outcome
13
patients
had
a
unilateral
adrenal
lesion,
including
unilateral
hyperplasia
and
unilateral
aldosterone-producing
adenomas,
and
8
had
bilateral
lesions.
1
patient
was
determined
to
have
no
aldosterone
overproduction.
12
patients
underwent
adrenalectomy
and
were
diagnosed
histologically,
and
10
patients
were
diagnosed
based
on
the
adrenal
venous
sampling
results,
imaging,
and
clinical
course.
The median cortisol level of the left central adrenal vein was 215 g/dL
The median cortisol level of the common trunk was 129 g/dL
The median plasma aldosterone concentrations of the central adrenal vein was 4,275 pg/mL
The median plasma aldosterone concentrations of the common trunk was 2,120 pg/mL
The median A/C ratios of the central adrenal vein was 278
Credits
SUMMARY
BY:
Justin
Shafa,
MSIV
The
George
Washington
University
School
of
Medicine
and
Health
Sciences
FULL
CITATION:
Takada
A,
Suzuki
K,
Naganawa
S,
et
al.
Clinical
Study:
Comparison
of
the
Central
Adrenal
Vein
and
the
Common
Trunk
of
the
LeH
Adrenal
Vein
for
Adrenal
Venous
Sampling.Journal
Of
Vascular
And
Interven4onal
Radiology
[serial
online].
April
1,
2013;24:550-557.
Available
from:
ScienceDirect,
Ipswich,
MA.
sirweb.org