How To Perform Adrenal Vein Sampling
The adrenal vein sampling video below by JVIR shows how to perform an AVS procedure. In addition, an explanation of adrenal vein sampling test, preparation, procedure, and how to interpret the results is also below.
This video was uploaded to YouTube by JVIR.
What is Adrenal Vein Sampling?
Adrenal vein sampling, also referred to as adrenal venous sampling, is a procedure in which blood samples are drawn from both adrenal glands to assess hormone production. Hypertension (high blood pressure) can be caused by aldosteronism when the adrenal glands produce too much aldosterone. Overproduction of aldosterone leads to imbalances that cause the body to hold on to too much water and increase blood pressure.
Adrenal Vein Sampling Test Procedure
For adrenal vein sampling preparation, aldosterone level, potassium level, and renin levels should be measured. In the absence of mineralocorticoid antagonists, the aldosterone/renin ratio (ARR) should be obtained. Pre-procedure imaging should be completed to determine if there is a mass present and if the patient lateralizes. This will help determine if there is unilateral hyperplasia or a functioning adenoma, and it will show if the patient could be a surgical candidate.
For the right adrenal vein, the 5F renal double curve catheter is preferred, but alternates, such as the Mickelson, C1, Hs2, SIM1, and SIM2, will also work. Begin by creating a small hold 1mm from the catheter tip on the superior surface. Place the catheter in IVC above the renal vein and turn the catheter ⅛ clockwise. Inject to evaluate the location when deflection occurs. The Simmons 3 catheter is preferred for the left adrenal vein. Create a small hold on the undersurface of the catheter tip.
Interpreting Adrenal Vein Sampling Results
An easy way to interpret adrenal vein sampling results is to make a table. This will help in calculating the selectivity index and the lateralization index. The three rows of the table will be: right, left, and IVC. The columns will be for aldosterone, cortisol, and the aldosterone/cortisol (A/C) ratio. Calculate the indexes for both the left and ride side. The selectivity index is (adrenal cortisol / IVC cortisol) and should be greater than or equal to 3. The lateralization index is (higher AC ratio value / lower AC ratio value) and will indicate if surgery is needed when the value is greater than or equal to 4. The A/C ratio is used instead of raw aldosterone values to account for dilution. Contralateral suppression occurs when aldosterone production from the left adrenal gland is suppressed. The right adrenal gland is independently producing excess aldosterone.
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