Central Surgical AssociationModification of the protocol for selective adrenal venous sampling results in both a significant increase in the accuracy and necessity of the procedure in the management of patients with primary hyperaldosteronism
Section snippets
Methods
After the publication of our initial AVS results, a critical appraisal of our practice was undertaken. After the identification of numerous factors believed to have contributed to this poor performance, a new protocol at the University of Calgary was instituted. Since 2006, all patients with documented PA deemed to be appropriate operative candidates, regardless of the imaging findings, were subjected to AVS performed by a single radiologist. ACTH (Cortrosyn) stimulation with a 250-μg bolus
Results
Eighty-six AVS procedures were performed in 84 patients. The median age of this group of patients was 50 years. Forty-four patients were female. Median systolic and diastolic blood pressures at presentation were 148 mm Hg and 90 mm Hg, respectively. Patients were on a median of 2.5 antihypertensive medications (range, 0–5). Hypokalemia was noted in 62% (52/84) patients at presentation. Median aldo:renin ratio was 14,950 (Table I). BAVC was documented in 82 of 86 procedures (95.3%), which
Discussion
During the critical appraisal of our AVS protocol, several factors believed to have limited performance were identified: (1) multiple radiologists; (2) multiple centers; (3) first-year fellows involved in 30% of procedures; (4) lack of ACTH infusion at some centers; and (5) inconsistent standards/cutoffs for interpretation. The described change in the AVS protocol at the University of Calgary resulted in a biochemical success rate of 95% since 2006. Our previously reported low success rate was
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