Techniques in adrenal vein sampling: Multipurpose catheter shape facilitates sampling of cranially oriented right adrenal veins.

Adrenal vein sampling (AVS) failure is often attributed to difficulty sampling the right adrenal vein (RAV). Normally, the RAV is caudally oriented, however, cranial orientation of the RAV is not uncommon. In such cases, use of a multipurpose (MPA) catheter shape may facilitate sampling. Between 2014 and 2019, 351 patients underwent AVS and RAV sampling with an MPA catheter occurred in 23 patients (7%, 10M:13F). Data regarding pre-AVS imaging, procedural details, and AVS results were collected, the RAV vertical angle was measured on venography using the IVC right lateral wall as the craniocaudal axis (0° defined as caudal, 180° cranial), and correlation of the number of catheters used until successful sampling with the MPA catheter and various procedural measures was assessed. Twenty-four technically successfully AVS were performed in 23 patients, all of whom had cranially oriented RAVs on intra-procedural venography. An MPA catheter was the first choice in 2 patients with previously known cranially oriented RAVs. In the remaining patients, the MPA catheter was 2nd choice in 21% (n = 5), 3rd choice in 50% (n = 12), and up to 8th choice (n=1). Early utilization of the MPA catheter correlated with lower fluoroscopic time (R = 0.71, P = 0.0001) and lower contrast volume (R = 0.77, P < 0.0001). These results support the use of the MPA catheter when sampling cranially oriented RAVs. MPA catheters should be readily considered when cranially oriented RAVs are present and when caudally-oriented catheters fail to identify the RAV.