Adrenal venous sampling (AVS) is an important procedure for determining primary aldosteronism (PA) subtypes. To guide the catheter to the adrenal veins and confirm cannulation, an iodinated contrast medium (ICM) is typically used. As an ultrasound-based device, the AcuNav intracardiac echocardiography (ICE) catheter allows for real-time visualization of vessels, offering a safer and less invasive option for patients at risk of using ICM. This report introduces a novel AVS technique using the AcuNav ICE catheter in two patients with PA with contraindications to ICM. One patient had a documented ICM allergy, and the other had active bronchial asthma. The AcuNav ICE catheter successfully enabled cannulation of the adrenal veins in both cases without the need for ICM or alternative agents. This ultrasound-guided technique is novel for AVS and highlights the potential of this method for broader applications in the management of patients with PA with ICM intolerance.
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