E-ISSN 1305-3612
Interventional Radiology - Original Article
Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures
1 Institution of Medicine at Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden.  
2 Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden (A.S.).  
Diagn Interv Radiol ; : -
DOI: 10.5152/dir.2018.17397

Purpose: Primary aldosteronism (PA) is a common cause of secondary hypertension. Adrenal venous sampling (AVS) is the gold standard for assessing laterality of PA, which is of paramount importance to decide adequate treatment. AVS is a technically complicated procedure with success rates ranging between 30-96%. The aim of this study was to investigate the success rate of AVS over time, performed by a single interventionist.


Methods: This was a retrospective study based on consecutive AVS performed by a single operator between September 2005 and June 2016. Data on serum concentrations of aldosterone and cortisol from right and left adrenal vein, inferior vena cava and peripheral vein were collected and selectivity index (SI) calculated. Successful AVS was defined as SI >5.


Results: In total, 282 AVS were performed on 269 patients, 168 (62%) men and 101 (38%) women, with a mean ± SD (range) age of 55 ± 11 (26-78) years. Out of 282 AVS, 259 were successful, giving an overall success rate of 92%. The most common reason for failure was inability to localize the right adrenal vein (n=16; 76%). The success rate was 63%, 82% and 94% during the first, second and third year, respectively. During the last 8 years the success rate was 95%, and on average 27 procedures were performed annually.


Conclusion: Satisfactory AVS success rate was achieved after approximately 36 procedures and maintenance of satisfactory success rate by performing approximately 27 procedures annually. AVS should be limited to few operators that perform sufficiently large number of procedures to achieve, and maintain, satisfactory AVS success rate.

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