Venous · IR Playbook

Adrenal Venous Sampling (AVS)

Adrenal venous sampling is selective catheterisation of both adrenal veins with paired sampling of aldosterone and cortisol to determine whether autonomous aldosterone secretion in confirmed primary aldosteronism is unilateral (surgically curable) or bilateral. It works because an aldosterone-producing lesion secretes into its own effluent vein at concentrations far above systemic levels, while cortisol in the same sample acts as an internal dilution marker — cortisol tells you whether you were actually in the adrenal vein, and the aldosterone-to-cortisol ratio corrects for the variable dilution by non-adrenal blood, so every interpretive rule and every failure mode of AVS follows from cortisol. Technical success exceeds 90% at high-volume centres, with the right adrenal vein accounting for almost all failures. Adrenal haemorrhage occurred in 16 of 2604 procedures (0.61%) in the multicentre AVIS study.

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