Adrenal vein sampling

Adrenal vein sampling (AVS) is a procedure where blood is collected from the adrenal veins via catheter to confirm autonomous hormone production, if it is unilateral or bilateral, and to guide further treatment.

Indication

AVS is commonly performed in primary aldosteronism, being indicated to identify aldosterone-secreting adenomas and to differentiate adenomas from bilateral adrenal hyperplasia. It can be performed also to identify a biochemically proved pheochromocytoma that is not visible at CT or MRI ¹. 

In rare occasions, AVS could be used for adrenal Cushing disease or for syndromes of androgen excess.

Technique

Although technique varies a standard modern approach would consist of ^1,3:

1. review prior imaging as CT or MRI
2. obtain a venous access from common femoral vein puncture with guiding catheter / microcatheter set-up
3. place selective catheter in IVC and sequentially cannulate and sample right followed by left adrenal vein
4. confirm catheter position with contrast injection
   1. Backback pain could be reported by the patient while contrast is injected into adrenal vein, particularly on the right
5. venous sampling from each adrenal vein and peripheral source (e.g., femoral vein)
   1. Somesome institutions use adrenocorticotropic hormone (ACTH) infusions before and during adrenal sampling.
   2. Otherother institutions avoid it due a suspicion of possible misdiagnosed bilateral cases ¹.
6. Labellabel all tubes (attention to right vs. left)
7. submit samples for laboratory assays (aldosterone and cortisol)