腎上腺靜脈採樣與影像及手術結果之關聯-單一醫學中心系列病例報告及文獻回顧

許淳淵¹、沈元琦¹、湯禹舜²、陳建旭¹、劉惠瑛¹、黃鏘綺³

¹高雄長庚紀念醫院 外科部 泌尿科；²高雄長庚紀念醫院 放射診斷科；³高雄長庚紀念醫院 內科部 腎臟科

Adrenal vein sampling and its correlation with image and surgical outcome - a single-center cases series and literature review

Chun-Yuan Hsu¹, YC Shen¹, Yu-Shun-Tang², CH Chen¹, Hui-Ying Liu¹, Chiang-Chi Huang³

Divisions of Urology¹, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Department of Diagnostic Radiology², Kaohsiung Chang Gung Memorial Hospital, Taiwan; Divisions of Nephrology³, Department of internal medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan

Purpose: Adrenal Vein Sampling (AVS) is a critical diagnostic tool in the subtyping of primary aldosteronism (PA), a condition characterized by excessive aldosterone secretion. The differentiation between unilateral and bilateral sources of this hormone overproduction is essential, as it informs the decision-making process for surgical intervention versus pharmacological management. Nevertheless, the success rates of AVS and subsequent patient outcomes are influenced by anatomical variations among patients and the proficiency of the physicians performing the procedure. This study was designed to evaluate the success rate of our institution's AVS procedures and to assess their correlation with imaging findings and surgical outcomes in patients.

Materials and Methods: In this case series study, we retrospectively reviewed patients diagnosed with primary aldosteronism who underwent AVS at our single institution between January 2021 and February 2024. The patients were subjected to unstimulated, sequential AVS with a minimum interval of 15 minutes between samples. A selectivity index (SI) greater than 1.5 was considered indicative of a successful AVS. We compared the AVS results with imaging studies. The postoperative outcomes were evaluated based on changes in blood pressure (BP) and potassium levels to determine clinical and biomedical success, respectively.

Results: A total of 27 patients, with a mean age of 55.7 years, were included in the study. Of these, 56% were female. The primary indications for PA testing were either resistant hypertension(40.7%, 11/27) or hypokalemia(29.6%, 8/27), or both(3.7%, 1/27). One patient's AVS procedure was aborted due to an immediate complication of a low abdominal wall hematoma. The bilateral success rate of AVS was 55.6% (15/27), while the failure rate was 22.2% (6/27) for the right adrenal vein, and 11.1% (3/27) for the left adrenal vein and 7.4%(2/27) for both adrenal veins. Concordance with computed tomography (CT) imaging was 60% (9/15). AVS-guided adrenalectomy demonstrated favorable clinical and biochemical outcomes.

Conclusion: The findings from this study suggest that AVS-guided adrenalectomy, when congruent with CT imaging, yields positive treatment outcomes. However, the selection of therapeutic strategies should not rely solely on AVS or CT. A larger cohort is necessary to reinforce these results and to enable a more comprehensive study. This will further elucidate the role of AVS in the management of primary aldosteronism and help optimize patient care.