To review the indications and techniques of adrenal vein sampling.

Primary Aldosteronism (PA) is the predominant cause of secondary hypertension, implicated in approximately 6% of all hypertensive patients, and up to 20% with refractory hypertension. It causes several sequelae independent of secondary hypertension, and therefore leads to greater morbidity/mortality than essential hypertension (1). Once diagnosis of PA is confirmed, it needs to be determined whether hormone production is unilateral or bilateral. The most likely cause of unilateral aldosterone production is aldosterone producing adenoma (APA). Less common aetiologies include nodular or diffuse unilateral hyperplasia. The best...

Prior to AVS, cross sectional imaging is undertaken to exclude some rarer causes of PA such as adrenal cortical carcinoma, which may warrant adrenalectomy without AVS. CT imaging is particularly useful as a pre-procedural planning tool, as it can help identify the location of the adrenal veins and establish any anatomical variants (4). Medications that affect the renin-angiotensin-aldosterone axis will need to be withheld for a predetermined amount of time, depending on the medications in question. Heparin may be administered to reduce the risk of...

PA remains a common illness that affects patients beyond causing hypertension, and AVS is performed to determine the laterality and therefore the correct treatment modality for each patient. It remains a technically challenging procedure, requiring proper training and experience to reduce iatrogenic complication rates and increase its diagnostic rate.

Quencer, KB. Adrenal vein sampling: technique and protocol, a systematic review. Cardiovascular and Interventional Radiology (CVIR) Endovascular. 2021; vol 4, no. 38 Rossi, GP. Primary Aldosteronism. Journal of the American College of Cardiology. 2019; Vol 74, no 22 Maiolino G, Rossitto G, Bisogni V, Cesari M, Seccia TM, Plebani M et al. Quantitative value of aldosterone-renin ratio for detection of aldosterone-producing adenoma: the aldosterone-renin ratio for primary aldosteronism (AQUARR) study. Journal of the American Heart Association. 2017; vol 6, no 5 Kahn SL, Angle JF....