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Venous Sampling and Venography (Renal and Adrenal)
Amir A. Borhani, MD; T. Gregory Walker, MD, FSIR; Zachary B. Jenner, MD
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KEY FACTS

  • Preprocedure

    • Procedure

      TERMINOLOGY

      • Synonyms

        • Renal vein sampling (RVS), renal vein renin sampling (RVRS)
      • Definitions

        • Primary aldosteronism (a.k.a. primary hyperaldosteronism): Hypersecretion of aldosterone by adrenal glands
          • Adrenal adenoma (Conn syndrome): Cause in 2/3 of cases
          • Bilateral idiopathic adrenal hyperplasia: Cause in remaining 1/3 of cases
        • Cushing syndrome: Clinical complex resulting from prolonged inappropriate exposure to glucocorticoids
          • Most frequently caused by administration of exogenous glucocorticoids or adrenocorticotrophic hormone (ACTH)
          • Endogenous causes include ACTH-secreting pituitary tumor, adrenal neoplasm (benign or malignant), or ectopic ACTH secretion by tumor
      • Adrenal Vein Anatomy

        • In most individuals, each gland has single main vein
          • Multiple adrenal veins occasionally occur
          • Adrenal veins communicate with retroperitoneal and renal capsular veins
        • Right adrenal vein drains directly into right posterolateral aspect of IVC
          • Typically located 2-4 cm above right renal vein
          • Small accessory hepatic vein may rarely drain into right adrenal vein or vice versa (10% incidence)
        • Left adrenal vein drains into superior aspect of left renal vein
          • Typically located 3-5 cm from left renal vein orifice
          • May very rarely drain directly into IVC
      • Renal Vein Anatomy

        • Usually each kidney is drained by single renal vein
          • Renal veins rarely have valves
          • Communicate with other retroperitoneal veins (e.g., lumbar, azygos, gonadal veins)
        • Left renal vein courses anterior to aorta and posterior to SMA to join IVC
          • Left renal vein drains somewhat anteriorly into IVC
        • Right renal vein is shorter, drains into IVC at about L2 vertebral level
        • Frequent variations in renal venous anatomy

      PREPROCEDURE

      • Indications

        • Contraindications

          • Preprocedure Imaging

            • Getting Started

              PROCEDURE

              • Patient Position/Location

                • Procedure Steps

                  • Findings and Reporting

                    • Alternative Procedures/Therapies

                      POST PROCEDURE

                      • Expected Outcome

                        • Things to Do

                          • Things to Avoid

                            OUTCOMES

                            • Problems

                              • Complications

                                Selected References

                                1. Rossi GP et al: An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 63(1):151-60, 2014
                                2. Kahn SL et al: Adrenal vein sampling. Tech Vasc Interv Radiol. 13(2):110-25, 2010
                                3. Georgiades CS et al: Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling. J Vasc Interv Radiol. 18(9):1102-5, 2007
                                4. Mengozzi G et al: Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism. Clin Chem. 53(11):1968-71, 2007
                                5. Rossi GP: New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism. Curr Hypertens Rep. 9(2):90-7, 2007
                                6. Nwariaku FE et al: Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg. 141(5):497-502; discussion 502-3, 2006
                                7. Hasbak P et al: Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings. J Hum Hypertens. 16(4):275-80, 2002
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Preprocedure

                                  • Procedure

                                    TERMINOLOGY

                                    • Synonyms

                                      • Renal vein sampling (RVS), renal vein renin sampling (RVRS)
                                    • Definitions

                                      • Primary aldosteronism (a.k.a. primary hyperaldosteronism): Hypersecretion of aldosterone by adrenal glands
                                        • Adrenal adenoma (Conn syndrome): Cause in 2/3 of cases
                                        • Bilateral idiopathic adrenal hyperplasia: Cause in remaining 1/3 of cases
                                      • Cushing syndrome: Clinical complex resulting from prolonged inappropriate exposure to glucocorticoids
                                        • Most frequently caused by administration of exogenous glucocorticoids or adrenocorticotrophic hormone (ACTH)
                                        • Endogenous causes include ACTH-secreting pituitary tumor, adrenal neoplasm (benign or malignant), or ectopic ACTH secretion by tumor
                                    • Adrenal Vein Anatomy

                                      • In most individuals, each gland has single main vein
                                        • Multiple adrenal veins occasionally occur
                                        • Adrenal veins communicate with retroperitoneal and renal capsular veins
                                      • Right adrenal vein drains directly into right posterolateral aspect of IVC
                                        • Typically located 2-4 cm above right renal vein
                                        • Small accessory hepatic vein may rarely drain into right adrenal vein or vice versa (10% incidence)
                                      • Left adrenal vein drains into superior aspect of left renal vein
                                        • Typically located 3-5 cm from left renal vein orifice
                                        • May very rarely drain directly into IVC
                                    • Renal Vein Anatomy

                                      • Usually each kidney is drained by single renal vein
                                        • Renal veins rarely have valves
                                        • Communicate with other retroperitoneal veins (e.g., lumbar, azygos, gonadal veins)
                                      • Left renal vein courses anterior to aorta and posterior to SMA to join IVC
                                        • Left renal vein drains somewhat anteriorly into IVC
                                      • Right renal vein is shorter, drains into IVC at about L2 vertebral level
                                      • Frequent variations in renal venous anatomy

                                    PREPROCEDURE

                                    • Indications

                                      • Contraindications

                                        • Preprocedure Imaging

                                          • Getting Started

                                            PROCEDURE

                                            • Patient Position/Location

                                              • Procedure Steps

                                                • Findings and Reporting

                                                  • Alternative Procedures/Therapies

                                                    POST PROCEDURE

                                                    • Expected Outcome

                                                      • Things to Do

                                                        • Things to Avoid

                                                          OUTCOMES

                                                          • Problems

                                                            • Complications

                                                              Selected References

                                                              1. Rossi GP et al: An expert consensus statement on use of adrenal vein sampling for the subtyping of primary aldosteronism. Hypertension. 63(1):151-60, 2014
                                                              2. Kahn SL et al: Adrenal vein sampling. Tech Vasc Interv Radiol. 13(2):110-25, 2010
                                                              3. Georgiades CS et al: Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling. J Vasc Interv Radiol. 18(9):1102-5, 2007
                                                              4. Mengozzi G et al: Rapid cortisol assay during adrenal vein sampling in patients with primary aldosteronism. Clin Chem. 53(11):1968-71, 2007
                                                              5. Rossi GP: New concepts in adrenal vein sampling for aldosterone in the diagnosis of primary aldosteronism. Curr Hypertens Rep. 9(2):90-7, 2007
                                                              6. Nwariaku FE et al: Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg. 141(5):497-502; discussion 502-3, 2006
                                                              7. Hasbak P et al: Hypertension and renovascular disease: follow-up on 100 renal vein renin samplings. J Hum Hypertens. 16(4):275-80, 2002