The adrenal vein sampling International study (avis) for identifying the major subtypes of primary aldosteronism

Gian Paolo Rossi, Marlena Barisa, Bruno Allolio, Richard J. Auchus, Laurence Amar, Debbie Cohen, Christoph Degenhart, Jaap Deinum, Evelyn Fischer, Richard Gordon, Ralph Kickuth, Gregory Kline, Andre Lacroix, Steven Magill, Diego Miotto, Mitsuhide Naruse, Tetsuo Nishikawa, Masao Omura, Eduardo Pimenta, Pierre Francois PlouinMarcus Quinkler, Martin Reincke, Ermanno Rossi, Lars Christian Rump, Fumitoshi Satoh, Leo Schultze Kool, Teresa Maria Seccia, Michael Stowasser, Akiyo Tanabe, Scott Trerotola, Oliver Vonend, Jiri Widimsky, Kwan Dun Wu, Vin Cent Wu, Achille Cesare Pessina

Research output: Contribution to journalArticlepeer-review

237 Citations (Scopus)


Context: In patients who seek surgical cure of primary aldosteronism (PA), The Endocrine Society Guidelines recommend the use of adrenal vein sampling (AVS), which is invasive, technically challenging, difficult to interpret, and commonly held to be risky. Objective: The aim of this study was to determine the complication rate of AVS and the ways in which it is performed and interpreted at major referral centers. Design and Settings: The Adrenal Vein Sampling International Study is an observational, retrospective, multicenter study conducted at major referral centers for endocrine hypertension worldwide. Participants: Eligible centers were identified from those that had published on PA and/or AVS in the last decade. Main Outcome Measure: The protocols, interpretation, and costs of AVS were measured, as well as the rate of adrenal vein rupture and the rate of use of AVS. Results: Twenty of 24 eligible centers from Asia, Australia, North America, and Europe participated and provided information on 2604 AVS studies over a 6-yr period. The percentage of PA patients systematically submitted to AVS was 77% (median; 19-100%, range). Thirteen of the 20 centers used sequential catheterization, and seven used bilaterally simultaneous catheterization; cosyntropin stimulation was used in 11 centers. The overall rate of adrenal vein rupture was 0.61%. It correlated directly with the number of AVS performed at a particular center (P = 0.002) and inversely with the number of AVS performed by each radiologist (P = 0.007). Conclusions: Despite carrying a minimal risk of adrenal vein rupture and at variance with the guidelines, AVS is not used systematically at major referral centers worldwide. These findings represent an argument for defining guidelines for this clinically important but technically demanding procedure.

Original languageEnglish
Pages (from-to)1606-1614
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Issue number5
Publication statusPublished - 2012 May

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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