What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism?
Article first published online: 20 OCT 2008
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Volume 70, Issue 1, pages 14–17, January 2009
How to Cite
Young, W. F. and Stanson, A. W. (2009), What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism?. Clinical Endocrinology, 70: 14–17. doi: 10.1111/j.1365-2265.2008.03450.x
- Issue published online: 30 DEC 2008
- Article first published online: 20 OCT 2008
- (Received 4 September 2008; returned for revision 27 September 2008; finally revised 11 October 2008; accepted 13 October 2008)
Adrenal venous sampling (AVS) is the criterion standard to distinguish between unilateral and bilateral adrenal disease in patients with primary aldosteronism. The keys to successful AVS include appropriate patient selection, careful patient preparation, focused technical expertise, defined protocol, and accurate data interpretation. The use of AVS should be based on patient preferences, patient age, clinical comorbidities, and the clinical probability of finding an aldosterone-producing adenoma. AVS is optimally performed in the fasting state in the morning. AVS is an intricate procedure because the right adrenal vein is small and may be difficult to locate – the success rate depends on the proficiency of the angiographer. The key factors that determine the successful catheterization of both adrenal veins are experience, dedication and repetition. With experience, and focusing the expertise to 1 or 2 radiologists at a referral centre, the AVS success rate can be as high as 96%. A centre-specific, written protocol is mandatory. The protocol should be developed by an interested group of endocrinologists, radiologists and laboratory personnel. Safeguards should be in place to prevent mislabelling of the blood tubes in the radiology suite and to prevent sample mix-up in the laboratory.