Evaluation of right adrenal vein cannulation by trans-catheter contrast-enhanced ultrasonography

Abstract

Abstract Background Adrenal vein sampling (AVS), the gold standard for confirmation of primary aldosteronism (PA) subtype, is technically challenging. Here, we assessed the benefit of trans-catheter contrast-enhanced ultrasonography (CEUS) in right adrenal gland imaging and its potential to improve the right AVS success rates among inexperienced interventionalists. Methods AVS was performed on all included PA patients (n = 61; 39 men; mean age, 52 ± 8.81 years) by a single interventionalist (who had no AVS experience prior to the study) between January 2020 and July 2022. Thirty-five patients underwent trans-catheter CEUS-assisted digital subtraction angiography (DSA)-guided AVS (CEUS-AVS), and 26 patients underwent DSA-guided AVS (DSA-AVS). In the CEUS-AVS group, following right adrenal vein cannulation, selective trans-catheter CEUS was performed to validate cannulation accuracy. Fisher’s exact test, two-sided Student’s t tests, and the Mann–Whitney test were used for statistical analysis. Results The right AVS success rate was higher in the CEUS-AVS than in the DSA-AVS group (94.29% vs. 73.08%, P = 0.03), but the left and bilateral AVS success rates did not differ. The ultrasound imaging success rate of the right adrenal vein was 97.1%. Right AVS was unsuccessful in nine patients (two in the CEUS-AVS and seven in the DSA-AVS group). Operative times did not differ, but radiation exposure times were shorter in CEUS-AVS patients (8.4 [6.00, 12.3] vs. 15.37 [7.23, 24.75], P = 0.04). Surgery-related complications were similar between groups. Conclusions CEUS-AVS can be used to confirm right adrenal vein cannulation accuracy, help inexperienced interventionalists rapidly improve AVS success rates, and shorten radiation exposure.