12463 Effect Of Multiple Blood Sampling In A Single Session On Adrenal Vein Sampling For Identification Of Primary Aldosteronism

Abstract Disclosure: N. Yagishita: None. M. Kometani: None. K. Aiga: None. R. Mizoguchi: None. T. Yoneda: None. Context: Adrenal vein sampling (AVS) is recognized as the gold standard method to distinguish subtypes of primary aldosteronism (PA), helps differentiating the pathogenic side and determining the appropriate treatment strategies. The Selectively Index (SI) and Lateralization Index (LI), which are based on aldosterone and cortisol levels, are used to determine the success rate of AVS and to diagnose PA subtypes. On the other hand, determining the success of adrenal vein insertion and disease type remains controversial, and various methods to improve its accuracy are still being reported. Objective: Evaluate the impact of performing multiple blood samplings from the inferior vena cava (IVC) and each adrenal vein (AV) during a single AVS session and its impact on the success rate of said AVS and the consequent accuracy of PA subtype diagnosis. Patients: A total of 48 patients who were diagnosed as PA and underwent multiple AVS procedures at Kanazawa University Hospital or Houju Memorial Hospital. Protocol: This study involved 48 patients diagnosed with PA. AVS was performed using the following procedure. A catheter is inserted into the IVC through the right or left femoral vein. A sample is first taken from the IVC (IVC-1). AVS was then performed in the order of right adrenal vein and left adrenal vein or vice versa. After cannulation of each adrenal vein, samples were taken three times before switching to the other adrenal vein. After the collection of each adrenal vein was completed, samples were taken again from the IVC (IVC-2). Results: Of the 48 patients, 44 patients were included in the study, for whom all sets of AVS samples were available. For each patient, six SI's were calculated per AV. Multiple AV samples did not affect the success rate of AVS. Regardless of the cortisol level in the AV, the SI calculated using the cortisol level in IVC -2 was significantly higher in most patients (P < 0.0001). Only patients in whom AVS was successful in all cases were selected to determine lateralization. Since nine different LI’s could be calculated, there were nine chances to determine subtypes for each patient. 18 patients in IVC-1 (left: 2, right: 4, bilateral: 12), 17 patients in IVC-2 (left: 3, right 2, bilateral: 12) all exhibited consistencies in lateralization. Except four patients which in both cases exhibited inconsistencies in lateralization. Conclusions: These results revealed that multiple blood samplings resulted in lateralization discrepancies that could not be determined with a single blood sampling. Although it was not possible to confirm that multiple blood samplings influence the success rate of AVS, it was newly confirmed that the timing of blood sampling from IVC impacts it. Presentation: 6/1/2024