Background: The presence of left renal vein (LRV) variants can increase the complexity of adrenal vein sampling (AVS), an already technically demanding procedure. While AVS literature often focuses on the right adrenal vein, an understanding of common LRV variants, their relationship with the left adrenal vein, and principles for successful catheterization can facilitate AVS. This guide provides practical, technical tips for AVS for duplicated (Du), circumaortic (Ca), and retroaortic (Ra) LRVs.
Methods: AVS cases were identified at a single institution (June 2009-March 2023) based on adrenophrenic trunk drainage relative to variant LRVs. Available cross-sectional imaging was reviewed to evaluate LRV anatomy pre-procedure. Twenty-seven cases (1 DuLRV, 13 CaLRVs, and 13 RaLRVs) were identified. Diagnostic AVS was confirmed by a threshold selectivity index. Literature on LRV anatomic variants was also reviewed.
Results: Based on the authors' experience and literature review, the following principles can guide AVS in the setting of LRV variants. In the presence of DuLRV or CaLRV, the left adrenal vein invariably drains into a normally positioned, pre-aortic LRV limb, so AVS can proceed as expected with a Simmons as the catheter of choice. In contrast, a LAV draining into a RaLRV may require a hockey stick-like catheter, or in rare cases a microcatheter, for selecting and sampling, due to the longer RaLRV course, which usually drains into the IVC more inferiorly and can be stenotic where the aorta crosses.
Conclusion: Knowing the presence and understanding the anatomy of LRV variants can facilitate an efficient AVS.
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http://dx.doi.org/10.1007/s00270-023-03534-7 | DOI Listing |
Vet Med Sci
January 2025
Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Jeollabuk-do, Republic of Korea.
A 13-year-old intact female Shih Tzu presented with anorexia, panting and pain of unknown origin. Physical examination was normal except for a systolic murmur (grade 3/6). Abdominal radiographs revealed an ill-defined area of increased opacity in the mid-abdomen.
View Article and Find Full Text PDFDiagnostics (Basel)
November 2024
Endocrinology Unit, Bnai Zion Medical Center, 47 Eliyahu Golomb Boulevard, Haifa 31048, Israel.
: To assess success rates and cost-effectiveness of adrenal venous sampling (AVS) after implementing point-of-care rapid cortisol (RC) testing conducted using a europium nanoparticle-based fluoro-immunoassay in patients with primary hyperaldosteronism. : A retrospective review of AVS procedures was conducted at our medical center between January 2016 and June 2024. The primary objective was to compare the success rates of AVS before and after the implementation of the RC testing.
View Article and Find Full Text PDFCurr Hypertens Rep
December 2024
Department of Endocrinology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88, Jiefang Road, Shangcheng District, Hangzhou, 310000, China.
Purpose Of Review: One of the challenges in the diagnosis and management of primary aldosteronism (PA), the most common type of secondary hypertension with curative potential, is the modification of antihypertensive medications. We seek to explore whether these medications can be continued during the diagnostic process of PA to minimize the duration and risks associated with medication adjustments.
Recent Findings: We searched PubMed for eligible original literature between 1990 and 2024 using the following keywords: (screening) AND (primary aldosteronism); (confirmatory) AND (primary aldosteronism); (adrenal vein sampling) AND primary aldosteronism).
Front Endocrinol (Lausanne)
December 2024
Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU) München, Munich, Germany.
Context: Primary aldosteronism (PA) is the most common form of endocrine hypertension. According to the Endocrine Society Practice Guidelines, the diagnosis of PA requires a pathological screening test result and non-suppressible aldosterone levels during confirmatory testing. Sequential testing with more than one confirmatory test may result in discordant test results.
View Article and Find Full Text PDFFolia Morphol (Warsz)
December 2024
Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan.
Background: The superior mesenteric vein appears as a fusion between irregularly-shaped slits of the midgut mesentery tissue at 5-6 weeks. In contrast, there might be no report when and how the inferior mesenteric vein (IMV) develops. We aimed to find the human initial IMV.
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