Abdominal pressing maneuver during adrenal venous sampling for stabilization of catheter position

The abdominal pressing maneuver (APM) is to control respiration movement of the right adrenal vein (RAV) during adrenal venous sampling (AVS). Instability of a catheter inserted into the RAV due to respiration movement can be a factor contributing to the unfeasibility of AVS.

Sixty-five consecutive patients who underwent AVS for primary aldosteronism were enrolled. We measured distances (D) of respiration movement of the RAV both without and with APM in patients who were resting breathing (n = 30) or deep breathing (n = 35). This method was clinically applied on 37 patients in whom the catheter became disconnected from the RAV either during venography or when collecting blood caused by respiration movement.

The average values for D-resting without APM and D-resting with APM were 7.6 (SD 2.5) and 3.6 (SD 1.7) mm, respectively, which was significantly different. The average values for D-deep without APM and D-deep with APM were 16.3 (SD 5.2) and 8.6 (SD 3.8) mm, which was also significantly different. The average control rates under conditions of deep or resting breathing were 45% [SD 17% (median 43%)] and 50% [SD 19% (median 49%)], respectively. The catheter was stable in 33 (88%) of 37 patients while using the APM.

The APM is considered convenient and feasible for successfully controlling respiration movement in patients undergoing AVS.