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A Novel Method: Super-selective Adrenal Venous Sampling
Published on: September 15, 2017
Arterial-venous adrenal embolization for aldosterone adenoma: a preliminary exploratory study
Zhi-Qiang Ma1,2, Hong-Liang Xiong1, Jiao Yang1
1Department of Cardiovascular Medicine, The 2nd Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, China.
Summary
Selective adrenal arterial and venous embolization (SAAVE) offers a new minimally invasive treatment for aldosterone-producing adenoma (APA). This technique effectively suppresses aldosterone and controls blood pressure, providing a safe alternative for patients unsuitable for surgery.
Area of Science:
- Endocrinology
- Interventional Radiology
- Nephrology
Background:
- Adrenalectomy is the standard treatment for aldosterone-producing adenoma (APA).
- Many patients cannot undergo surgery, necessitating alternative treatments.
- Selective adrenal arterial embolization (SAAE) has shown limited efficacy due to incomplete arterial occlusion.
Purpose of the Study:
- To evaluate the efficacy and safety of selective adrenal arterial and venous embolization (SAAVE) for treating left-sided APA.
- To compare SAAVE with SAAE in terms of hormonal suppression and biochemical remission.
- To assess the impact of SAAVE on blood pressure and serum potassium levels.
Main Methods:
- Prospective enrollment of 11 patients with left-sided APA undergoing SAAVE.
- Retrospective analysis of 40 patients who previously underwent SAAE.
- Propensity score matching (PSM) to adjust for baseline differences between SAAVE and SAAE groups.
- Primary endpoint: change in plasma aldosterone concentration (PAC) at 3 months.
Main Results:
- SAAVE significantly reduced PAC by -65.17 ± 52.63 ng/dL (P = 0.002) and normalized serum potassium.
- SAAVE lowered 24-h ambulatory blood pressure (ΔSBP -16.91 ± 20.16 mmHg; ΔDBP -9.55 ± 12.19 mmHg).
- SAAVE achieved a higher complete biochemical remission rate (81.8%) compared to SAAE (35.0%, P = 0.014), sustained after PSM (P = 0.030).
- No major adverse events were observed, and cortisol levels remained stable.
Conclusions:
- SAAVE is an effective and safe minimally invasive treatment for left-sided APA.
- Combining arterial and venous embolization enhances hormonal suppression and blood pressure control.
- SAAVE presents a viable alternative for APA patients who are not surgical candidates.