SIR 2024
Venous Interventions
Matthew Hung, MD (he/him/his)
Interventional Radiology Resident
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
Financial relationships: Full list of relationships is listed on the CME information page.
Heather Wachtel, MD
Assistant Professor of Surgery
Hospital of the University of Pennsylvania
Disclosure information not submitted.
Debbie L. Cohen, MBBCH
Professor of Medicine
Hospital of the University of Pennsylvania
Disclosure information not submitted.
Douglas Fraker, MD
Professor of Surgery
Hospital of the University of Pennsylvania
Disclosure information not submitted.
Scott O. Trerotola, MD
Associate Chair and Chief, Interventional Radiology
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
AVS was technically successful in all 46 patients. The plasma aldosterone concentration in the non-suppressed group was significantly higher compared to the suppressed group (41.2 ng/dL vs. 24 ng/dL, p < 0.001). The ARR in the non-suppressed group was significantly lower compared to the suppressed group (29.9 vs. 109.5, p < 0.001). The proportion of patients in the non-suppressed group who had a lateralization index > 4 was lower than that in the suppressed group, although this did not reach significance (43% vs. 61%, p = 0.38). The mean lateralization index in the non-suppressed group trended lower compared to the suppressed group (8.7 vs. 16.6, p = 0.10). Within the non-suppressed group, patients who lateralized had a significantly higher ARR compared to those who did not (36.4 vs. 27.8, p = 0.04). The proportion of patients in the non-suppressed group who were able to decrease the number of medications in their antihypertensive regimen following adrenalectomy was similar to that of patients in the suppressed group who also underwent surgery (88% vs. 100%, p = 0.62). All hypokalemic patients in both the non-suppressed and suppressed groups who underwent adrenalectomy had normalization of their potassium levels following surgery.
Conclusion:
Nearly half of patients with non-suppressed PRA lateralized with AVS. The patients who did lateralize had similar blood pressure response and correction of hypokalemia following adrenalectomy, regardless of plasma renin activity. Therefore, patients with a non-suppressed PRA (greater than 1 ng/ml/h) should still be considered for AVS provided the ARR is elevated.