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Adrenal venous sampling (AVS) is currently the best available confirmatory test for lateralising aldosterone production in proven primary aldosteronism (PA).1 AVS is an invasive procedure, which carries a small risk of complications, but requires skilled radiologist to obtain biochemically selective samples.2 The technical success rate of AVS has been cited up to 96% in specialised centres,3 whereas unsuccessful AVS is primarily due to failure in cannulating the right adrenal vein, because of its challenging anatomy. Furthermore, in spite of ‘radiologically successful’ cannulation of both adrenal veins, the samples obtained can still be non-diagnostic due to dilution and lack of selectivity.
Following a revision of our AVS protocol (both radiological and biochemical) in 2012, we assessed its impact on the success rate of the procedure. We carried out a retrospective review of all AVS performed in the interventional radiology department since 2008. Prior to 2012 (pre-2012 protocol), three interventional radiologist (IR) performed AVS in randomly allotted slots without cosyntropin stimulation using a size 5 French (Fr) SIM2 Glidecath (Terumo, Somerset, New Jersey) as the preferred catheter for cannulation. As per the revised protocol (post-2012 protocol), two IR (combined experience of >24 years) were designated to perform all AVS procedures and patients were booked as the first case in the morning list. All received cosyntropin bolus intravenously (250 μg in 5 mL of 0.9% saline) an …
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