Techniques in adrenal vein sampling: Multipurpose catheter shape facilitates sampling of cranially oriented right adrenal veins

Abstract

Adrenal vein sampling (AVS) failure is often attributed to difficulty in sampling the right adrenal vein (RAV). Normally, the RAV is caudally oriented; however, cranial orientation of the RAV is not uncommon. In such cases, use of a multipurpose catheter may facilitate sampling. Between 2014 and 2019, 351 patients underwent AVS and RAV sampling, with a multipurpose catheter used in 23 patients (7%, 10 male, 13 female patients). Data regarding pre-AVS imaging, procedural details, and AVS results were collected, the RAV vertical angle was measured on venography using the inferior vena cava (IVC) right lateral wall as the craniocaudal axis (0° defined as caudal, 180° cranial), and correlation between the number of catheters used until successful sampling with the multipurpose catheter and various procedural measures was assessed. Twenty-four technically successful AVS procedures were performed in 23 patients, all of whom had cranially oriented RAVs on intra-procedural venography. A multipurpose catheter was the first choice in 2 patients with previously known cranially oriented RAVs. In the remaining patients, the multipurpose catheter was the second choice in 21% (n = 5), third choice in 50% (n = 12), and up to the eighth choice (n = 1). Early utilization of the multipurpose catheter correlated with lower fluoroscopic time (r = .71, P = .0001) and lower contrast volume (r = .77, P < .0001). These results support the use of the multipurpose catheter when sampling cranially oriented RAVs. Multipurpose catheters should be readily considered when cranially oriented RAVs are present and when caudally oriented catheters fail to identify the RAV.