<em>Adrenal venous sampling at westmead hospital a</em><em> retrospective audit of technical success operator variation and diagnostic outcomes</em> — ASN Events
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Adrenal venous sampling at westmead hospital a retrospective audit of technical success operator variation and diagnostic outcomes (#344)

Jackson Harper 1 , Emma Hartley 1 , Christopher Chan 1 , Sue-Lynn Lau 1 , Andrew-Hyun Lee 1 , Ngai Wah Cheung 1
  1. Endocrinology , Department of Endocrinology, Westmead Hospital, Sydney , NSW, Australia

 

Background/Aims: The 2025 Endocrine Society guideline recommends screening all individuals with hypertension for primary hyperaldosteronism, potentially increasing referrals for adrenal venous sampling (AVS) (1). AVS is technically challenging - bilateral adrenal vein cannulation (BAVC) success improves with increasing procedural experience and dedicated operator training (2,3). Australian and New Zealand recommendations advise a single proceduralist where annual AVS volume is <20 procedures(4,5). We audited BAVC success at Westmead Hospital and subsequent AVS interpretation.

 

Methods: All AVS procedures performed from January 2021 to June 2026 were reviewed. Successful BAVC was defined as selectivity index ≥3. BAVC success was assessed overall and by proceduralist. AVS interpretations were classified as bilateral secretion, left or right sided lateralisation, biochemically indeterminate despite successful cannulation, or technically indeterminate (unsuccessful BAVC).

 

Results: Ninety procedures were identified; six excluded because of insufficient data. 84 procedures (46 female, 38 male) represented 79 individual patients and nine proceduralists. Mean age was 50.2 ± 11.8 years. BAVC was successful in 57 procedures (67.9%); 23 (27.4%) achieved left-sided cannulation only and four (4.8%) cannulated neither side.

 

Of 57 successful procedures, 32 (38.1%) confirmed bilateral aldosterone excess, 10 (11.9%) confirmed right-sided lateralisation, four (4.8%) confirmed left-sided lateralisation and 11 (13.1%) were biochemically indeterminate with regards to aldosterone excess. Among proceduralists performing more than two procedures, success ranged from 57.1% to 87.5%. BAVC was higher in males than females (76.3% vs 60.9%), but not significantly (OR 2.07, 95% CI 0.80–5.38; p=0.16).

 

Conclusion: BAVC was achieved in approximately two-thirds of procedures, with right adrenal vein cannulation the principal technical limitation. Transparent auditing of procedural outcomes may encourage changes in practice, including concentrating AVS procedures among selected experienced operators in line with ANZ recommendations and improving case-load allocation, thereby supporting procedural learning and better outcomes.

 

  1. 1. Adler GK, et al. Primary Aldosteronism: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2025;110(9):2453–2595.
  2. 2. Jakobsson H, Farmaki K, Sakinis A, et al. Adrenal venous sampling: the learning curve of a single interventionalist with 282 consecutive procedures. Diagn Interv Radiol. 2018;24(2):89–93.
  3. 3. Pauzi KNM, et al. Success rate of adrenal venous sampling and its associated factors. Ann Vasc Surg. 2024.
  4. 4. Yang J, Bell DA, Carroll R, et al. Adrenal vein sampling for primary aldosteronism: recommendations from the Australian and New Zealand Working Group. Clin Endocrinol (Oxf). 2025;102(1):31–43.
  5. 5. So CB, Leung AA, Chin A, Kline GA. Adrenal venous sampling in primary aldosteronism: lessons from over 600 single-operator procedures. Clin Radiol. 2022;77(2)–e179.