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Effect of antihypertensive medication therapy on adrenal vein sampling measures
JVIR
’
Scientific Session
4:06 PM
Wednesday
Abstract No. 310
Thrombolytic interventions in the portal and mesenteric veins: a retrospective review of our institutional experience M.M. Khadir, S. Gilani, A. Sharma, D. Butani, T. Sasson, D.L. Waldman, J. Xue; University of Rochester, Rochester, NY
4:15 PM
Abstract No. 311
Effect of antihypertensive medication therapy on adrenal vein sampling measures R.N. Srinivasa, B.N. Andring, S.P. Reis; Radiology, University of Texas Southwestern Medical Center, Dallas, TX Purpose: Although data exists for the discontinuation of mineralocorticoid receptor antagonists prior to adrenal vein sampling (AVS), the consensus statement on AVS by the American Heart Association notes that there are no studies supporting the feasibility of other classes of antihypertensive medications on AVS measures. We assess here the effect that these blood pressure medications have on lateralization indices in AVS in patients with suspected primary hyperaldosteronism.
S141
Materials and Methods: A retrospective review of 102 technically successful AVS procedures performed between 2009 and 2014 at two hospitals in a single academic institution was performed. There were 60 males and 42 females with a mean age of 52 years (range 32 - 79 years). The classes of all antihypertensive medications that each patient was taking at the time of AVS were recorded including: beta adrenergic antagonists, ACE inhibitors, angiotensin-II-receptor antagonists, alpha adrenergic antagonists, alpha-2-receptor agonists, dihydropyridine and non-dihydropyridine calcium channel blockers, diuretics, vasodilators and direct renin inhibitors. Of note, in all cases mineralocorticoid receptor antagonists were held prior to AVS and thus were not included in analysis. All patients received cosyntropin stimulation during AVS. Lateralization indices (LI) were recorded for all patients, defined as the higher aldosterone to cortisol (AC) ratio divided by the lower AC ratio, with LI Z 4.0 considered positive for lateralization. Lastly, clinical outcomes in those undergoing adrenalectomy were recorded. Results: Our data reveal no statistically significant difference between mean lateralization ratios for any class of antihypertensive medication being taken at the time of AVS. Fisher’s exact test reveals no statistically significant difference between those taking a particular class of medication and lateralization outcome on AVS for any class of antihypertensive. Further, none of these medications correlated with clinical success or failure after adrenalectomy. Conclusion: AVS can be successfully performed and interpreted in patients on therapy with various classes of antihypertensive medications.
4:24 PM
Abstract No. 312
Adrenal vein sampling: a simple method to increase the technical success rate A. Palumbo, M. Borge, C. Molvar; Vascular and Interventional Radiology, Loyola University Medical Center, Chicago, IL Purpose: Adrenal vein sampling is considered the gold standard for distinguishing unilateral aldosterone-secreting adenomas from bilateral adrenal hyperplasia, but has a reputation as a difficult procedure. Our institution employs obtaining samples from multiple sites in the region of the adrenal veins to ensure that the adrenal vein is sampled. The purpose of this study is to show that increasing the number of vessels sampled increases efficacy without significantly increasing cost. Materials and Methods: A retrospective database was constructed containing 66 AVS procedures performed over a 5-year period. The single highest cortisol value on the right, left, and low cava were used to calculate the selectivity index (SI) for each procedure. Cost analysis of processing the samples was also performed. Results: From the 66 AVS procedures, 242 samples were obtained from the right (ave ¼ 3.7) and 155 from the left (ave ¼ 2.3). The single highest cortisol values obtained from the left and right (n¼132) were used to calculate the selectivity index (SI). Technical success was defined by an SI 4 5. Using this cutoff, 87% of total samples were diagnostic (n¼115), with diagnostic results obtained from 82% of the right and 92% of the left samples. Operator 1 performed 52/66 AVS with a total of 165 samples from the right (ave ¼ 3.2) and 97 from the left (ave ¼ 1.9). Overall, 86% of the single highest cortisol samples
WEDNESDAY: Scientific Sessions
Purpose: We describe our experience with endovascular pharmacomechanical treatment of portomesenteric venous thrombosis (PMVT), discuss outcomes, and review complications. Materials and Methods: This retrospective study examined 16 patients (12 male, 4 female; average age 46 years, range, 1667 years) who were selected for treatment with endovascular techniques after PMVT was diagnosed on imaging. Transhepatic access to the portal venous system was achieved using ultrasound or fluoroscopic guidance. Patients were treated with combined pharmacomechanical thrombolysis including the use of the Angiojet Thrombectomy System (Medrad), alteplase (tPA), and balloon angioplasty. In all patients post thrombolysis venogram was performed to evaluate patency of the portomesenteric venous (PMV) system. Results: Ten out of 16 patients (63%) had complete PMV patency and six patients (37%) had partial patency immediately after treatment. One patient with complete PMV patency initially had rethrombosis within 24 hours of treatment. A second patient had complete patency until 27 days post procedure at which point complete rethrombosis was seen on Doppler imaging. Major complications included death in two patients within 24 hours of treatment, while minor complications included access site hematoma (n ¼ 2) and a perihepatic hematoma not requiring transfusion (n ¼ 1). None of the patients required bowel resection after thrombolytic therapy. All of the 14 patients who survived thrombolysis were discharged from the hospital and there was no 30-day mortality. Conclusion: To our knowledge, this cohort study presents the largest reported series of endovascular interventions in the PMV system, including an unprecedented number of cases using Angiojet for mechanical thrombolyis. We were able to achieve immediate PMV patency in all of our patients and long-term patency in the majority. Thus, we consider combined pharmacomechanical thrombolysis to be an effective intervention in PMVT.
’
’
Scientific Session
4:06 PM
Wednesday
Abstract No. 310
Thrombolytic interventions in the portal and mesenteric veins: a retrospective review of our institutional experience M.M. Khadir, S. Gilani, A. Sharma, D. Butani, T. Sasson, D.L. Waldman, J. Xue; University of Rochester, Rochester, NY
4:15 PM
Abstract No. 311
Effect of antihypertensive medication therapy on adrenal vein sampling measures R.N. Srinivasa, B.N. Andring, S.P. Reis; Radiology, University of Texas Southwestern Medical Center, Dallas, TX Purpose: Although data exists for the discontinuation of mineralocorticoid receptor antagonists prior to adrenal vein sampling (AVS), the consensus statement on AVS by the American Heart Association notes that there are no studies supporting the feasibility of other classes of antihypertensive medications on AVS measures. We assess here the effect that these blood pressure medications have on lateralization indices in AVS in patients with suspected primary hyperaldosteronism.
S141
Materials and Methods: A retrospective review of 102 technically successful AVS procedures performed between 2009 and 2014 at two hospitals in a single academic institution was performed. There were 60 males and 42 females with a mean age of 52 years (range 32 - 79 years). The classes of all antihypertensive medications that each patient was taking at the time of AVS were recorded including: beta adrenergic antagonists, ACE inhibitors, angiotensin-II-receptor antagonists, alpha adrenergic antagonists, alpha-2-receptor agonists, dihydropyridine and non-dihydropyridine calcium channel blockers, diuretics, vasodilators and direct renin inhibitors. Of note, in all cases mineralocorticoid receptor antagonists were held prior to AVS and thus were not included in analysis. All patients received cosyntropin stimulation during AVS. Lateralization indices (LI) were recorded for all patients, defined as the higher aldosterone to cortisol (AC) ratio divided by the lower AC ratio, with LI Z 4.0 considered positive for lateralization. Lastly, clinical outcomes in those undergoing adrenalectomy were recorded. Results: Our data reveal no statistically significant difference between mean lateralization ratios for any class of antihypertensive medication being taken at the time of AVS. Fisher’s exact test reveals no statistically significant difference between those taking a particular class of medication and lateralization outcome on AVS for any class of antihypertensive. Further, none of these medications correlated with clinical success or failure after adrenalectomy. Conclusion: AVS can be successfully performed and interpreted in patients on therapy with various classes of antihypertensive medications.
4:24 PM
Abstract No. 312
Adrenal vein sampling: a simple method to increase the technical success rate A. Palumbo, M. Borge, C. Molvar; Vascular and Interventional Radiology, Loyola University Medical Center, Chicago, IL Purpose: Adrenal vein sampling is considered the gold standard for distinguishing unilateral aldosterone-secreting adenomas from bilateral adrenal hyperplasia, but has a reputation as a difficult procedure. Our institution employs obtaining samples from multiple sites in the region of the adrenal veins to ensure that the adrenal vein is sampled. The purpose of this study is to show that increasing the number of vessels sampled increases efficacy without significantly increasing cost. Materials and Methods: A retrospective database was constructed containing 66 AVS procedures performed over a 5-year period. The single highest cortisol value on the right, left, and low cava were used to calculate the selectivity index (SI) for each procedure. Cost analysis of processing the samples was also performed. Results: From the 66 AVS procedures, 242 samples were obtained from the right (ave ¼ 3.7) and 155 from the left (ave ¼ 2.3). The single highest cortisol values obtained from the left and right (n¼132) were used to calculate the selectivity index (SI). Technical success was defined by an SI 4 5. Using this cutoff, 87% of total samples were diagnostic (n¼115), with diagnostic results obtained from 82% of the right and 92% of the left samples. Operator 1 performed 52/66 AVS with a total of 165 samples from the right (ave ¼ 3.2) and 97 from the left (ave ¼ 1.9). Overall, 86% of the single highest cortisol samples
WEDNESDAY: Scientific Sessions
Purpose: We describe our experience with endovascular pharmacomechanical treatment of portomesenteric venous thrombosis (PMVT), discuss outcomes, and review complications. Materials and Methods: This retrospective study examined 16 patients (12 male, 4 female; average age 46 years, range, 1667 years) who were selected for treatment with endovascular techniques after PMVT was diagnosed on imaging. Transhepatic access to the portal venous system was achieved using ultrasound or fluoroscopic guidance. Patients were treated with combined pharmacomechanical thrombolysis including the use of the Angiojet Thrombectomy System (Medrad), alteplase (tPA), and balloon angioplasty. In all patients post thrombolysis venogram was performed to evaluate patency of the portomesenteric venous (PMV) system. Results: Ten out of 16 patients (63%) had complete PMV patency and six patients (37%) had partial patency immediately after treatment. One patient with complete PMV patency initially had rethrombosis within 24 hours of treatment. A second patient had complete patency until 27 days post procedure at which point complete rethrombosis was seen on Doppler imaging. Major complications included death in two patients within 24 hours of treatment, while minor complications included access site hematoma (n ¼ 2) and a perihepatic hematoma not requiring transfusion (n ¼ 1). None of the patients required bowel resection after thrombolytic therapy. All of the 14 patients who survived thrombolysis were discharged from the hospital and there was no 30-day mortality. Conclusion: To our knowledge, this cohort study presents the largest reported series of endovascular interventions in the PMV system, including an unprecedented number of cases using Angiojet for mechanical thrombolyis. We were able to achieve immediate PMV patency in all of our patients and long-term patency in the majority. Thus, we consider combined pharmacomechanical thrombolysis to be an effective intervention in PMVT.
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