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Updated: Jul 17, 2025
06:08
A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
23.5K
A Practical Guide for Left Adrenal Vein Sampling in Patients with Left Renal Vein Variants
Monica M Matsumoto1, Daniel Picus2, Scott O Trerotola3
1Department of Radiology, University of Pennsylvania Health System, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA. monica.matsumoto1@pennmedicine.upenn.edu.
Cardiovascular and Interventional Radiology
|August 28, 2023
Summary
Understanding left renal vein (LRV) variants is crucial for successful adrenal vein sampling (AVS). This guide offers practical tips for performing AVS with duplicated, circumaortic, and retroaortic LRVs.
Area of Science:
- Vascular anatomy
- Interventional radiology
Background:
- Left renal vein (LRV) variants complicate adrenal vein sampling (AVS).
- Existing literature primarily addresses right adrenal vein AVS, neglecting LRV variations.
- This guide details AVS techniques for duplicated (Du), circumaortic (Ca), and retroaortic (Ra) LRVs.
Purpose of the Study:
- To provide practical, technical guidance for adrenal vein sampling (AVS) in the presence of left renal vein (LRV) variants.
- To enhance the efficiency and success rate of AVS procedures.
- To elucidate the relationship between common LRV variants and the left adrenal vein.
Main Methods:
- Retrospective review of 27 AVS cases with LRV variants (DuLRV, CaLRVs, RaLRVs) from June 2009 to March 2023.
- Analysis of cross-sectional imaging to assess LRV anatomy pre-procedure.
- Literature review on LRV anatomic variants and their implications for AVS.
Main Results:
- For duplicated (Du) or circumaortic (Ca) LRVs, the left adrenal vein typically drains into a pre-aortic LRV limb, allowing standard AVS with a Simmons catheter.
- For retroaortic (Ra) LRVs, catheter selection may require a hockey stick or microcatheter due to the longer course and potential stenosis.
- Successful AVS was confirmed by achieving a threshold selectivity index.
Conclusions:
- Familiarity with left renal vein (LRV) variants and their specific anatomy is essential for efficient adrenal vein sampling (AVS).
- Tailored catheter selection based on LRV variant anatomy improves AVS success rates.
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