title: Coaxial guide wire placement in the right adrenal vein for repeated adrenal venous samplings.
abstract: OBJECTIVE
  Many adrenal venous sampling (AVS) protocols require repeated samplings before and after adrenocorticotrophic hormone (ACTH) stimulation. Maintaining catheter selectivity in the adrenal vein over time is essential but can be challenging, especially in the short right adrenal vein, where the catheter is often in an unstable position. The aim of our study was to evaluate guide wire insertion into the right adrenal vein catheter to sustain AVS selectivity (adrenal/peripheral cortisol ratio [Ca/Cp]) over time.
  
  
  METHODS
  This retrospective investigation was approved by our institutional review board, and informed consent was obtained. A 0.014-inch guide wire was inserted in the right adrenal vein 5F catheter to secure its positioning and to facilitate blood sampling. Plasma cortisol levels from the left and right adrenal veins and left iliac vein were assessed in 117 consecutive patients undergoing bilateral, simultaneous sets of AVS at -5 and 0 min (baseline) and 5, 10, and 15 min after intravenous bolus of 250 μg ACTH (stimulated). Ca/Cp ratios of ≥2 for baseline and >10 for stimulated AVS were considered selective.
  
  
  RESULTS
  The first sampling, at time -5 min, was nonselective in 41 of 116 (35.3 %) right and 30 of 116 (25.9 %) left AVSs retained for analysis. In patients with a selective first sampling, 74 of 75 (98.7 %) right and 85 of 86 (98.8 %) left AVSs were selective in all post-ACTH samplings. Right and left selectivity rates were not statistically different (p > 0.87). No complications arose from guide wire insertion.
  
  
  CONCLUSIONS
  Guide wire insertion into the right adrenal vein catheter is safe and effective to maintain AVS selectivity over time.
authors: Division of Interventional Radiology, Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 3840 Saint-Urbain St, Montréal, QC, H2W 1T8, Canada, youri13@gmail.com.
authors: Youri
authors: Y
authors: Kaitoukov
authors: Gilles
authors: G
authors: Soulez
authors: Vincent L
authors: VL
authors: Oliva
authors: Marie-France
authors: MF
authors: Giroux
authors: Isabelle
authors: I
authors: Bourdeau
authors: André
authors: A
authors: Lacroix
authors: Patrick
authors: P
authors: Gilbert
authors: Eric
authors: E
authors: Therasse
mesh_terms: D000236:Adenoma / Q000097:blood; D000310:Adrenal Gland Neoplasms / Q000097:blood; D000311:Adrenal Glands / Q000098:blood supply* / Q000000981:diagnostic imaging; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012189:Retrospective Studies; D014680:Veins
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone