Evaluation of right adrenal vein cannulation by trans-catheter contrast-enhanced ultrasonography: A retrospective comparative study

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. 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 exact test, two-sided Student t tests, and the Mann-Whitney test were used for statistical analysis. The right AVS success rate was higher in the CEUS-AVS than in the DSA-AVS group (94.29% vs 73.08%, P = .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 9 patients (two in the CEUS-AVS and 7 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 = .04). Surgery-related complications were similar between groups. CEUS-AVS can be used to confirm right adrenal vein cannulation accuracy, help inexperienced interventionalists rapidly improve AVS success rates, and shorten radiation exposure.