title: A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism.
abstract: BACKGROUND
  Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a "gold standard" procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease.
  
  
  OBJECTIVE
  The aim of this study was to present our single-centre experience in establishing and implementating the AVS procedure.
  
  
  METHODS
  All patients had primary aldosteronism confirmed in a salt-infusion test. AVS was performed sequentially during a continuous intravenous infusion of cosyntropin and was preceded by multislice contrast-enhanced computed tomography (CT) examination of adrenal glands performed a few weeks before AVS in the majority of patients. AVS was regarded as successful if the ratio of each adrenal vein cortisol to inferior vena cava cortisol levels (selectivity index [SI]) was higher than 3.0. In the case of failure, a second attempt was considered in a few weeks. Patients were divided into four groups according to the order of the procedure by quartiles.
  
  
  RESULTS
  Between 31 May, 2012 and 5 May, 2016, AVS was performed in 124 patients (69% males, aged 55.3 ± 10.3 years) and was successful in 120 (96.8%) patients. All failed cases were due to the failure of cannulation of the right adrenal vein. The first-attempt success rate was 94.3% (117 of 124 patients) and increased from 83.9% in the first 31 patients to 100% in the last 31 patients. Similarly, the overall success rate increased from 93.5% to 100%. The right SI was significantly higher than the left one (26.4 vs. 11.0, p < 0.0001). Both indices did not differ across quartiles of patients. No complications occurred during the procedure.
  
  
  CONCLUSIONS
  The AVS procedure, preceded by adrenal CT, may be implemented into daily diagnostic practice safely with an excellent success rate.
authors.affiliation: Department of Invasive Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. kadziela@ikard.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kądziela
authors.forename: Aleksander
authors.initials: A
authors.lastname: Prejbisz
authors.forename: Ilona
authors.initials: I
authors.lastname: Michałowska
authors.forename: Sylwia
authors.initials: S
authors.lastname: Kołodziejczyk-Kruk
authors.forename: Leo
authors.initials: L
authors.lastname: Schultze Kool
authors.forename: Marek
authors.initials: M
authors.lastname: Kabat
authors.forename: Hanna
authors.initials: H
authors.lastname: Janaszek-Sitkowska
authors.forename: Sadegh
authors.initials: S
authors.lastname: Toutounchi
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gałązka
authors.forename: Urszula
authors.initials: U
authors.lastname: Ambroziak
authors.forename: Tomasz
authors.initials: T
authors.lastname: Bednarczuk
authors.forename: Dorota
authors.initials: D
authors.lastname: Ptasińska-Wnuk
authors.forename: Michał
authors.initials: M
authors.lastname: Hoffmann
authors.forename: Magdalena
authors.initials: M
authors.lastname: Januszewicz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Januszewicz
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D000311:Adrenal Glands / Q000098:blood supply*; D000368:Aged; D001800:Blood Specimen Collection / Q000592:standards*; D002404:Catheterization / Q000592:standards*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006929:Hyperaldosteronism / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D014680:Veins
chemical_list: D006854:Hydrocortisone
keywords: adrenal vein sampling; primary aldosteronism; secondary hypertension