The Adrenal Vein Sampling International Study (AVIS) for Identifying the Major Subtypes of Primary Aldosteronism

  1. Gian Paolo Rossi
  2. Marlena Barisa
  3. Bruno Allolio
  4. Richard J. Auchus
  5. Laurence Amar,
  6. Debbie Cohen
  7. Christoph Degenhart
  8. Jaap Deinum
  9. Evelyn Fischer
  10. Richard Gordon,
  11. Ralph Kickuth
  12. Gregory Kline
  13. Andre Lacroix
  14. Steven Magill
  15. Diego Miotto,
  16. Mitsuhide Naruse
  17. Tetsuo Nishikawa
  18. Masao Omura
  19. Eduardo Pimenta,
  20. Pierre-François Plouin
  21. Marcus Quinkler
  22. Martin Reincke
  23. Ermanno Rossi,
  24. Lars Christian Rump
  25. Fumitoshi Satoh
  26. Leo Schultze Kool
  27. Teresa Maria Seccia,
  28. Michael Stowasser
  29. Akiyo Tanabe
  30. Scott Trerotola
  31. Oliver Vonend
  32. Jiri Widimsky Jr.,
  33. Kwan-Dun Wu
  34. Vin-Cent Wu and 
  35. Achille Cesare Pessina

Author Affiliations

  1. University of Padova (G.P.R., M.B., T.M.S., A.C.P.), Department of Medicine (DIMED) Internal Medicine 4, Padova, 35128 Italy; University Hospital Würzburg (B.A.), Department of Internal Medicine I, Endocrine and Diabetes Unit, Würzburg, 97080 Germany; University of Texas (R.J.A.), Southwestern Medical Center at Dallas, Dallas, Texas 75390; Hôpital Européen Georges Pompidou (L.A., P.-F.P.), Hypertension Unit, Paris, 75908 France; Hospital of The University of Pennsylvania (D.C.), Department of Internal Medicine, Philadelphia, Pennsylvania 19104; University Hospital Innenstadt (C.D.), Department of Clinical Radiology, Munich, 80336 Germany; Radboud University Nijmegen (J.D.), Department of Internal Medicine, Nijmegen, 6225GA Netherlands; University Hospital Innenstadt (E.F., M.R.), Department of Endocrinology, Munich, Germany; University of Queensland School of Medicine (R.G., E.P., M.S.), Greenslopes Hospital, Endocrine Hypertension Research Centre, Brisbane, 4120 Australia; University Hospital Würzburg (R.K.), Institute of Radiology, Würzburg, Germany; University of Calgary (G.K.), Foothills Medical Centre, Calgary, T2N4J8 Canada; Centre hospitalier de l’Université de Montréal (A.L.), Department of Medicine, Montreal, H2W 1T8 Canada; Medical College of Wisconsin (S.M.), Endocrinology Clinic Community Memorial Medical Commons, Menomonee Falls, Wisconsin 53051; University of Padova (D.M.), Department of Medicine (DIMED) Radiology, Padova, Italy; National Hospital Organization Kyoto Medical Center (M.N.), Department of Endocrinology Clinical Research Institute, Kyoto, 612-8555 Japan; Yokohama Rosai Hospital (T.N., M.O.), Department of Endocrinology and Metabolism, Yokohama City, 222-0036 Japan; Clinical Endocrinology (M.Q.), Charité Campus Mitte, Charité University Medicine Berlin, Berlin, 10117 Germany; Azienda Ospedaliera Santa Maria Nuova (E.R.), Department of Internal Medicine, Reggio Emilia, 42123 Italy; Department of Nephrology (L.C.R., O.V.), Heinrich-Heine-University Düsseldorf, Düsseldorf, 40225 Germany; Tohoku University Hospital (F.S.), Department of Nephrology, Endocrinology and Vascular Medicine, Sendai, 980-8574 Japan; Department of Radiology (L.S.K.), Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; Institute of Clinical Endocrinology (A.T.), Tokyo Women’s Medical University, Tokyo, 162-8666 Japan; Hospital of The University of Pennsylvania (S.T.), Department of Radiology, Philadelphia, Pennsylvania; Charles University in Prague (J.W.), General Faculty Hospital, Third Department of Medicine, Prague, 12808 Czech Republic; and National Taiwan University Hospital (K.-D.W., V.-C.W.), Department of Internal Medicine, Taipei, 10048 Taiwan
  1. Address all correspondence and requests for reprints to: Prof. Gian Paolo Rossi, M.D., FACC, FAHA, Department of Medicine, Internal Medicine 4, University Hospital via Giustiniani, 2, 35126 Padova, Italy. E-mail:



Context: In patients who seek surgical cure of primary aldosteronism (PA), The Endocrine Society Guidelines recommend the use of adrenal vein sampling (AVS), which is invasive, technically challenging, difficult to interpret, and commonly held to be risky.

Objective: The aim of this study was to determine the complication rate of AVS and the ways in which it is performed and interpreted at major referral centers.

Design and Settings: The Adrenal Vein Sampling International Study is an observational, retrospective, multicenter study conducted at major referral centers for endocrine hypertension worldwide.

Participants: Eligible centers were identified from those that had published on PA and/or AVS in the last decade.

Main Outcome Measure: The protocols, interpretation, and costs of AVS were measured, as well as the rate of adrenal vein rupture and the rate of use of AVS.

Results: Twenty of 24 eligible centers from Asia, Australia, North America, and Europe participated and provided information on 2604 AVS studies over a 6-yr period. The percentage of PA patients systematically submitted to AVS was 77% (median; 19–100%, range). Thirteen of the 20 centers used sequential catheterization, and seven used bilaterally simultaneous catheterization; cosyntropin stimulation was used in 11 centers. The overall rate of adrenal vein rupture was 0.61%. It correlated directly with the number of AVS performed at a particular center (P = 0.002) and inversely with the number of AVS performed by each radiologist (P = 0.007).

Conclusions: Despite carrying a minimal risk of adrenal vein rupture and at variance with the guidelines, AVS is not used systematically at major referral centers worldwide. These findings represent an argument for defining guidelines for this clinically important but technically demanding procedure.

  • Received October 14, 2011.
  • Accepted January 31, 2012.




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