title: Impact of accessory hepatic veins on adrenal vein sampling for identification of surgically curable primary aldosteronism.
abstract: Adrenal vein sampling is the gold standard for identification of surgically curable primary aldosteronism, but its accuracy might be hindered by blood dilution from accessory vein blood. We prospectively investigated the presence of accessory veins draining into adrenal veins and their effect on the selectivity index (SI) in 74 consecutive patients undergoing adrenal vein sampling. On the right side, the venous anatomic pattern could be conclusively determined in 91.8% of the cases: we detected hepatic accessory veins in 12.1%, no accessory veins in 42.4%, and renal capsular veins in 45.5%. On the left side there was a phrenico-adrenal trunk in 89.4% and renal capsular accessory veins in 10.6% of the cases. On both sides, renal capsular and phrenic accessory veins did not affect the SI. At variance, on the right side, hepatic accessory veins were associated with SI values approximately 3-fold lower than that found when such accessory veins were absent (median: 3.10 [range: 0.80 to 84.2] versus median: 1.10 [range: 0.70 to 2.20]; P=0.01). However, superselective adrenal catheterization resulted into higher SI values (median: 23.88; range: 4.80 to 84.20) in these cases. Thus, hepatic accessory veins sharing egress into the inferior vena cava with the right adrenal vein occurred in approximately 12% of the patients and imply a low SI, likely because of adrenal blood dilution by hepatic blood carrying a low cortisol concentration. In the presence of this anatomic variation, superselective catheterization of the right adrenal vein should be undertaken to determine the lateralization of aldosterone secretion.
authors.affiliation: Department of Clinical and Experimental Medicine-Clinica Medica 4, University Hospital, via Giustiniani 2, Padua, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Renzo
authors.initials: R
authors.lastname: De Toni
authors.forename: Gisella
authors.initials: G
authors.lastname: Pitter
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Seccia
authors.forename: Raffaella
authors.initials: R
authors.lastname: Motta
authors.forename: Matteo
authors.initials: M
authors.lastname: Vincenzi
authors.forename: Gianpietro
authors.initials: G
authors.lastname: Feltrin
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000315:Adrenalectomy; D000450:Aldosterone / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D006503:Hepatic Veins / Q000002:abnormalities*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D000450:Aldosterone; D006854:Hydrocortisone