Adrenal Venous Sampling
This section provides a comprehensive procedural report for adrenal venous sampling procedure with up-to-date explanatory notes, synopsis of the indications and contraindications, and potential complications in an organized and practical format.
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Sandra Abi Fadel
Abbreviations
ACTH CT DHEA MRI
Adrenocorticotropic hormone Computed tomography Dehydroepiandrosterone Magnetic resonance imaging
INTRODUCTION Adrenal venous sampling consists of simultaneous or sequential sampling of the bilateral adrenal veins, before and after the administration of adrenocorticotropic hormone (ACTH) intravenously, for localization of pathology before adrenalectomy in Conn, Cushing, and adrenogenital syndromes. Adrenal venous sampling has a high accuracy rate of nearly 100 %.
COMMON INDICATIONS [1–4] • To localize the adenoma in patients with clinical and laboratory evidence of primary hyperaldosteronism and equivocal results of noninvasive imaging modalities
• To lateralize the adenoma in patients with clinical and laboratory evidence of primary hyperaldosteronism and apparent bilateral adrenal disease on noninvasive imaging modalities • To localize the adenoma in patients with clinical and laboratory evidence of ACTH-independent Cushing syndrome with equivocal noninvasive imaging results • To localize the adrenal adenoma in patients with clinical and laboratory evidence of virilization and equivocal noninvasive imaging results
COMMON CONTRAINDICATIONS [1] • • • •
Increased bleeding diathesis Accelerated hypertension Significant ischemic heart disease Allergy to contrast
S. Abi Fadel (&) Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, Beirut 1107 2020, Lebanon e-mail: [email protected] © Springer International Publishing Switzerland 2016 B. Taslakian et al. (eds.), Procedural Dictations in Image-Guided Intervention, DOI 10.1007/978-3-319-40845-3_129
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POSSIBLE COMPLICATIONS [2, 4, 5] • Infection of the puncture site • Groin hematoma • Venous spasm causing failure procedure • Rupture of the adrenal vein • Adrenal gland infarction • Adrenal Hemorrhage • Hypertensive crisis • Adrenal insufficiency
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PREPROCEDURAL ASSESSMENT AND PLANNING • History, indications, and physical examination (Appendix 1 in Chap. 149) • Evaluation of diagnostic imaging studies (ultrasound, MRI, CT) to determine the location of the adrenal veins • Periprocedural management of coagulation status (Appendices 2 in Chap. 150 and 3 in Chap. 151) • Antibiotic prophylaxis: Not routinely recommended [6] • Imaging modality for guidance: Fluoroscopy, ultrasound for localization of the femoral vein for puncture • Positioning: Supine
PROCEDURE NOTE Procedure: Fluoroscopic-guided percutaneous bilateral adrenal venous sampling with ACTH stimulation Staff:: [_] Fellow:: [_] Resident:: [_] Clinical Information: Describe history and list indications Allergies: None known/Allergic to [specify/type of allergy] Anesthesia: Local anesthesia/conscious sedation Medications: List any relevant medications used (sedation, ACTH)
Contrast Used: (_) mL of [type] contrast media was used for intravenous injection Field: Sterile Procedure classification: Clean Position: Supine Monitoring: Intravenous access line was secured and vital signs were cont
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