Department of Internal Medicine, Charles University Prague, Medical Faculty Hradec Kralove, University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic.
Cardiovasc Intervent Radiol. 2010 Aug;33(4):760-5. doi: 10.1007/s00270-009-9722-4. Epub 2009 Oct 1.
Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.
肾上腺静脉采样 (AVS) 通常被认为是鉴别原发性醛固酮增多症单侧和双侧醛固酮分泌过多的金标准。然而，在 AVS 过程中，我们注意到来自右侧肾上腺的样本中醛固酮浓度存在相当大的差异。这些样本中的一些醛固酮浓度甚至低于下腔静脉样本。我们假设这些低醛固酮水平的样本并非来自右侧肾上腺，而是来自肝静脉。因此，我们试图分析无意穿刺肝静脉对 AVS 的影响。连续纳入 30 例接受 AVS 的患者。在我们的标准化 AVS 方案中实施了肝静脉采样。前瞻性收集和分析数据。27 例患者（90%）AVS 成功，所有操作均成功穿刺肝静脉。肝静脉和下腔静脉样本的皮质醇浓度无显著差异，但肝静脉血中醛固酮浓度（中位数，17 pmol/L；范围，40-860 pmol/L）明显低于下腔静脉样本（中位数，860 pmol/L；范围，460-4510 pmol/L）。观察到的差异具有统计学意义（P < 0.001）。肝静脉中的醛固酮浓度明显低于从下腔静脉采集的静脉血。这一发现对 AVS 很重要，因为由于其解剖位置接近，肝静脉很容易被误认为是肾上腺静脉。
