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OS 35-07 A NOVEL METHOD FOR ADRENAL VEIN SAMPLING VIA MEDIAN CUBITAL VEIN.

OBJECTIVE: Adrenal venous sampling (AVS) is recommended by clinical guidelines to distinguish surgically curable types of primary aldosteronism, but remains widespread underused mainly due to difficulty in successful sampling. When considering that the right adrenal vein is angled caudally, AVS through upper extremity approach may be more appropriate. The purpose of this study was to establish the technique ofAVS via median cubital vein (MCV), and evaluate its safety and feasibility.

DESIGN AND METHOD: From January 2012 to June 2015, 194 consecutive patients diagnosed as primary aldosteronism underwent AVS via MCV at the Fuwai Hospital. Patients were assigned to 2 main groups: usual catheterization for bilateral adrenal cannulations (group I, case 1-29), whereas in group2, catheter speicification with MPA1 catheter used for right adrenal vein cannulationand TIG catheter was used for left adrenal vein was done (group II, case 30-194). Group II was further divided into 3 sequential subgroups (group IIa, case 30-84; group IIb, case 85-139; group IIc, case 140-194). Successful sampling was defined by high selectivity index (cortisol in the adrenal vein/cortisol in inferior vena cava ≥ 2).

RESULTS: 170 (87.6%) of 194 patients were successful sampled bilaterally. The success rate increased from 79.3% in groupI to 89.1% in group II (P = 0.215) and the three procedure related parameters (the mean time of the procedure, mean fluoroscopy time, and mean dosage of contrast) decreased significantly (all P < 0.001). The successful sampling rate was gradually increased with time in group II (group IIa:87.3%;group IIb:89.1%;group IIc:90.9%), although this did not reach statistical significance. Compared with group IIa, the three parameters were significantly lower in group IIb and IIc (P < 0.05). There was no significant difference between group IIb and IIc (P > 0.05). The incidence of adrenal hematoma and intima injury was 1.0% (2/194) and 1.0% (2/194).

CONCLUSIONS: This first-in-man study showed AVS via MCV was safe and feasible, with a high rate of successful sampling.

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