ARRS 2022 Abstracts


E1712. Adrenal Vein Sampling: A Primer for Interventional Radiology Residents
  1. Chris O'Sullivan; Texas A&M College of Medicine
  2. Varun Rachakonda; Houston Methodist
  3. Mark Sultenfuss; Houston Methodist; Texas A&M College of Medicine
Adrenal vein sampling (AVS) is a procedure being performed more frequently due to the rising identification of primary hyperaldosteronism. The predominant causes of hyperaldosteronism are unilateral adenoma and bilateral hyperplasia. AVS is utilized to distinguish between them. Differentiating between the two pathologies is important for clinical follow-up and treatment planning. If an adenoma is identified it can be surgically removed, whereas medical management is employed for bilateral hyperplasia. This exhibit reviews the pathophysiology of hyperaldosteronism and covers the steps and imaging characteristics of AVS.

Educational Goals / Teaching Points
This educational exhibit will begin by reviewing the indications for adrenal vein sampling with discussion of underlying pathophysiology and pre-operative imaging and planning. Then, it will overview the normal and variant anatomy of adrenal glands. Finally, this exhibit will cover the steps of AVS to include techniques, common pitfalls, and outcomes.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy of the adrenal glands will be reviewed to include hormonal control, vascular supply, and venous drainage. Key characteristics of adrenal nodules and the differential diagnosis on CT imaging will be discussed as part of the pre-procedural workup. Understanding of the pathophysiology with knowledge of normal and variant vascular anatomy is essential for successful AVS. A discussion on the steps of AVS will include identifying adrenal glands fluoroscopically, an overview of selectivity and lateralization, and complications. Anatomy and pathology will be illustrated through multiple modalities in this exhibit.

The increased diagnosis of primary hyperaldosteronism necessitates the need for familiarity and comfortability with AVS for both radiologists and primary providers. Correctly utilizing this procedure leads to improved patient care and outcomes, necessitating a strong foundation in AVS for both interventional radiology residents and attendings. This exhibit aims to provide this foundation by reviewing the indications for AVS and covering procedural steps, techniques, and pitfalls.