Comparison

of the Central Adrenal Vein and

the Common Trunk of the Le7 Adrenal Vein for
Adrenal Venous Sampling
RFS Journal Primer

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%.

Adrenal vein sampling is used to determine whether aldosterone hypersecretion is unilateral or

bilateral.

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

Small sample size: n = 22 at a single institution

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

22 patients with suspected primary aldosteronism undergoing adrenal vein

sampling

Time range: November 2010 to August 2011

INCLUSION CRITERIA

Patients underwent 1 or 2 con?irmatory tests for aldosterone excess: an oral

sodium test, saline solution infusion test, captopril challenge test, and
furosemide plus upright test.

Patients underwent an enhanced CT scan to detect the adrenal veins and screen
the adrenal glands.

Hypertension not accounted for by any other etiology.

EXCLUSION CRITERIA

Unsuccessful blood sampling from the adrenal vein

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

Procedures were performed under local anesthesia

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.

This was followed by sampling of blood at the common trunk

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

The median A/C ratios of the common trunk was 244

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.

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