Purpose of review: To describe the current indications for adrenal vein sampling (AVS), variability in institutional protocols for performing the procedure, shortage of expert interventional radiologists trained in this procedure, pitfalls in technique and strategies to improve success. A major emphasis of the review will focus on the interpretation of the AVS results.
Recent findings: Published protocols for performance of the AVS procedure and variability in the diagnostic criteria differentiating aldosterone-producing adenoma from bilateral adrenal hyperplasia vary significantly. Inability to catheterize the right adrenal vein is the major reason for technical failure of AVS. Preplanning computed tomography, stat intraprocedural cortisol levels and cone-beam computed tomography are helpful in identifying the right adrenal vein. The administration of adrenocorticotropic hormone stimulation during AVS varies significantly between different studies.
Summary: More interested interventional radiologists need to acquire the necessary technical expertise for AVS due to increased demand for the procedure, which is the diagnostic reference standard for primary aldosteronism. Unresolved issues include variability in the AVS procedure protocol, use of adrenocorticotropic hormone stimulation and standardization of the interpretation of the results. Despite all these variables, many different approaches still appear to be clinically successful, as indicated by the extensive published reports.