The inferior accessory hepatic vein: an anatomic landmark in adrenal vein sampling

Abstract

Purpose: To evaluate the use of the inferior accessory hepatic vein (IAHV) as an anatomic marker for the right adrenal vein (RAV) for adrenal vein sampling (AVS) and the use of a renal double curve (RDC) catheter to sample the RAV.

Materials and methods: In 73 patients undergoing AVS, an RDC catheter was first directed laterally and withdrawn from the hepatic vein confluence inferiorly. If the catheter engaged the IAHV, this location was documented. A search for the RAV was conducted using the standard technique. If the IAHV was present, its distance from the RAV was measured. Alternate catheters and ultimately successful shape were recorded. A sequential poststimulation technique was used in all patients.

Results: The IAHV was found in 42 of 73 patients (58%). The mean RAV to IAHV distance was 4.4 mm ± 4.7 (range 0-20 mm); it was 5 mm or less in 30 of 42 patients (71%) with an IAHV or 30 of 73 (41%) patients overall. In patients with an IAHV, RAV sampling was successful in 40 of 42 (95%). In 61 of 73 patients (84%), the RDC catheter was successful in localizing the RAV. In those patients, the RAV sample was adequate in 60 of 61 (98%) versus 9 of 12 (75%) in the remainder (P = .013). Overall, AVS was technically successful in 67 of 73 patients (92%).

Conclusions: The IAHV, when present, may help localize the RAV; this knowledge could help increase diagnostic yield for less experienced operators. The RDC catheter has a high yield in RAV sampling.