44 - Improving Adrenal Vein Sampling: Utilizing the Combined Angio-CT Hybrid Suite

Purpose: To evaluate the impact of combined Angio-CT hybrid suite on adrenal vein sampling (AVS) procedures compared with fluoroscopy-only procedures.

Materials and Methods: Retrospective, single-center review of all patients who underwent AVS from 2017 to 2025 at our academic institution in Chicago, IL, USA. With the acquisition of a hybrid Angio-CT procedure suite (Alphenix 4D CT, Canon Medical Systems USA, Tustin, CA), our AVS technique transitioned to adapt intra-procedural multi-detector CT (MDCT) capabilities for confirmation of adrenal vein cannulation. We hypothesized the use of MDCT for confirmation of adrenal cannulation would decrease procedure duration and radiation dose, while improving technical and diagnostic success. Patients were separated based on AVS procedures with or without hybrid Angio-CT use. Analyzed data included procedure duration, fluoroscopy and radiation exposure, technical success defined as bilateral adrenal vein cannulation on imaging, and laboratory success defined as successful adrenal vein cannulation confirmed by cortisol and aldosterone chemical testing.

Results: There were 47 patients who underwent AVS during the study period, 24 (51.1%) male and 23 female (48.9%) with a mean age of 42 years. A total of 27 (57.4%) patients underwent AVS with combined Angio-CT, and 20 (42.6%) patients underwent AVS without Angio-CT. Four (20%) patients in the cohort without Angio-CT and no (0%) patients in the cohort with Angio-CT underwent repeat procedures; 2/4 (50%) repeat procedures were technically unsuccessful. For patients with combined Angio-CT, technical success was 25/27 (92.6%) compared with 13/20 (65%) in fluoroscopy-only patients, resulting in statistically significant improved success with the use of Angio-CT compared to fluoroscopy-only (p=0.026). Technical success was consistent with laboratory success in all cases. Procedure duration also significantly decreased (p=0.00008) for Angio-CT cases with a mean procedure time of 119.59 +/- 52.59 minutes compared with a fluoroscopy-only mean procedure time of 214.50 +/- 107.17 minutes. There was no statistically significant change in fluoroscopy time (p=0.47) or radiation dose from fluoroscopy (p=0.48). There were no (0%) immediate procedural complications in either cohort.

Conclusion: Use of a hybrid Angio-CT suite and adapted AVS technique results in significantly decreased procedure duration and improved procedural success.