Department of Nephrology, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany.
Hypertension. 2011 May;57(5):990-5. doi: 10.1161/HYPERTENSIONAHA.110.168484. Epub 2011 Mar 7.
In patients with primary aldosteronism, adrenal venous sampling is helpful to distinguish between unilateral and bilateral adrenal diseases. However, the procedure is technically challenging, and selective bilateral catheterization often fails. The aim of this analysis was to evaluate success rate in a retrospective analysis and compare data with procedures done prospectively after introduction of measures designed to improve rates of successful cannulation. Patients were derived from a cross-sectional study involving 5 German centers (German Conn's registry). In the retrospective phase, 569 patients with primary aldosteronism were registered between 1990 and 2007, of whom 230 received adrenal venous sampling. In 200 patients there were sufficient data to evaluate the procedure. In 2008 and 2009, primary aldosteronism was diagnosed in 156 patients, and adrenal venous sampling was done in 106 and evaluated prospectively. Retrospective evaluation revealed that 31% were bilaterally selective when a selectivity index (cortisol adrenal vein/cortisol inferior vena cava) of ≥2.0 was applied. Centers completing <20 procedures had success rates between 8% and 10%. Overall success rate increased in the prospective phase from 31% to 61%. Retrospective data demonstrated the pitfalls of performing adrenal venous sampling. Even in specialized centers, success rates were poor. Marked improvements could be observed in the prospective phase. Selected centers that implemented specific measures to increase accuracy, such as rapid-cortisol-assay and introduction of standard operating procedures, reached success rates of >70%. These data demonstrate the importance of throughput, expertise, and various potentially beneficial measures to improve adrenal vein sampling.
在原发性醛固酮增多症患者中，肾上腺静脉采样有助于区分单侧和双侧肾上腺疾病。然而，该操作具有技术挑战性，且选择性双侧导管插入术通常会失败。本分析的目的是在回顾性分析中评估成功率，并与引入旨在提高成功插管率的措施后前瞻性进行的程序数据进行比较。这些患者来自涉及 5 个德国中心（德国 Conn's 注册中心）的一项横断面研究。在回顾性阶段，1990 年至 2007 年间登记了 569 例原发性醛固酮增多症患者，其中 230 例接受了肾上腺静脉采样。200 例患者有足够的数据来评估该程序。2008 年和 2009 年，诊断出 156 例原发性醛固酮增多症患者，并对其中 106 例进行了前瞻性肾上腺静脉采样和评估。回顾性评估显示，当应用选择性指数（皮质醇肾上腺静脉/皮质醇下腔静脉≥2.0）时，31%为双侧选择性。完成<20 例操作的中心成功率在 8%至 10%之间。前瞻性阶段的总体成功率从 31%增加到 61%。回顾性数据显示了执行肾上腺静脉采样的陷阱。即使在专门的中心，成功率也很低。在前瞻性阶段，可以观察到明显的改善。选择实施了提高准确性的特定措施的中心，例如快速皮质醇测定和引入标准操作程序，成功率超过 70%。这些数据表明了吞吐量、专业知识和各种潜在有益措施对于改善肾上腺静脉采样的重要性。
