title: The Adrenal Vein Sampling International Study (AVIS) for identifying the major subtypes of primary aldosteronism.
abstract: BACKGROUND
  In patients who seek surgical cure of primary aldosteronism (PA), The Endocrine Society Guidelines recommend the use of adrenal vein sampling (AVS), which is invasive, technically challenging, difficult to interpret, and commonly held to be risky.
  
  
  OBJECTIVE
  The aim of this study was to determine the complication rate of AVS and the ways in which it is performed and interpreted at major referral centers.
  
  
  METHODS
  The Adrenal Vein Sampling International Study is an observational, retrospective, multicenter study conducted at major referral centers for endocrine hypertension worldwide.
  
  
  METHODS
  Eligible centers were identified from those that had published on PA and/or AVS in the last decade.
  
  
  METHODS
  The protocols, interpretation, and costs of AVS were measured, as well as the rate of adrenal vein rupture and the rate of use of AVS.
  
  
  RESULTS
  Twenty of 24 eligible centers from Asia, Australia, North America, and Europe participated and provided information on 2604 AVS studies over a 6-yr period. The percentage of PA patients systematically submitted to AVS was 77% (median; 19-100%, range). Thirteen of the 20 centers used sequential catheterization, and seven used bilaterally simultaneous catheterization; cosyntropin stimulation was used in 11 centers. The overall rate of adrenal vein rupture was 0.61%. It correlated directly with the number of AVS performed at a particular center (P = 0.002) and inversely with the number of AVS performed by each radiologist (P = 0.007).
  
  
  CONCLUSIONS
  Despite carrying a minimal risk of adrenal vein rupture and at variance with the guidelines, AVS is not used systematically at major referral centers worldwide. These findings represent an argument for defining guidelines for this clinically important but technically demanding procedure.
authors.affiliation: University of Padova, Department of Medicine (DIMED) Internal Medicine 4, Padova, 35128 Italy. gianpaolo.rossi@unipd.it
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Rossi
authors.forename: Marlena
authors.initials: M
authors.lastname: Barisa
authors.forename: Bruno
authors.initials: B
authors.lastname: Allolio
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Auchus
authors.forename: Laurence
authors.initials: L
authors.lastname: Amar
authors.forename: Debbie
authors.initials: D
authors.lastname: Cohen
authors.forename: Christoph
authors.initials: C
authors.lastname: Degenhart
authors.forename: Jaap
authors.initials: J
authors.lastname: Deinum
authors.forename: Evelyn
authors.initials: E
authors.lastname: Fischer
authors.forename: Richard
authors.initials: R
authors.lastname: Gordon
authors.forename: Ralph
authors.initials: R
authors.lastname: Kickuth
authors.forename: Gregory
authors.initials: G
authors.lastname: Kline
authors.forename: Andre
authors.initials: A
authors.lastname: Lacroix
authors.forename: Steven
authors.initials: S
authors.lastname: Magill
authors.forename: Diego
authors.initials: D
authors.lastname: Miotto
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Naruse
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishikawa
authors.forename: Masao
authors.initials: M
authors.lastname: Omura
authors.forename: Eduardo
authors.initials: E
authors.lastname: Pimenta
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Plouin
authors.forename: Marcus
authors.initials: M
authors.lastname: Quinkler
authors.forename: Martin
authors.initials: M
authors.lastname: Reincke
authors.forename: Ermanno
authors.initials: E
authors.lastname: Rossi
authors.forename: Lars Christian
authors.initials: LC
authors.lastname: Rump
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Satoh
authors.forename: Leo
authors.initials: L
authors.lastname: Schultze Kool
authors.forename: Teresa Maria
authors.initials: TM
authors.lastname: Seccia
authors.forename: Michael
authors.initials: M
authors.lastname: Stowasser
authors.forename: Akiyo
authors.initials: A
authors.lastname: Tanabe
authors.forename: Scott
authors.initials: S
authors.lastname: Trerotola
authors.forename: Oliver
authors.initials: O
authors.lastname: Vonend
authors.forename: Jiri
authors.initials: J
authors.lastname: Widimsky
authors.forename: Kwan-Dun
authors.initials: KD
authors.lastname: Wu
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
authors.forename: Achille Cesare
authors.initials: AC
authors.lastname: Pessina
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000328:Adult; D001800:Blood Specimen Collection / Q000379:methods*; D002404:Catheterization; D003937:Diagnosis, Differential; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies