Failed Catheterization of the Right Adrenal Vein: When Incomplete Adrenal Venous Sampling Data Can Be Used to Direct a Surgical Cure

Adrenal venous sampling (AVS) is technically demanding. The success rate of sampling both adrenal veins is ≈95% at centers of excellence. However, at medical centers with low AVS case volume or where multiple interventional radiologists perform AVS, the success rate can be as low at 30%. When AVS is not successful, it is almost always due to lack of successful sampling of the right adrenal vein. The right adrenal vein is small and enters the inferior vena cava (IVC) at an acute angle. When the right adrenal vein is not sampled but the left adrenal production of aldosterone is suppressed, it can be inferred that the right adrenal gland is the source of aldosterone hypersecretion.