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Pre-Procedure Medications
Pre-Procedure Medications
Do not discontinue
Medications that do not interfere with the renin-angiotensin system
Long-acting calcium channel blockers (verapamil or diltiazem)
α1-adrenergic receptor blockers (doxazosin mesylate, long-acting dihydropyridine)
β-blockers
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor blockers
Discontinue for 4 weeks before AVS
Loop and thiazide diuretics
Amiloride
Mineralocorticoid receptor antagonists
Exception:
If plasma renin activity is suppressed, AVS can be safely performed regardless of the duration of the withdrawal of the medication.
A 2-week withdrawal protocol has been suggested for those who cannot tolerate discontinuation of the antihypertensives for longer than four weeks.
Pre-Procedure Adrenal Stimulation:
Pre-Procedure Adrenal Stimulation:
Cosyntropin 250 mcg in 100 mL saline
Begin infusion 30 minutes before sampling @ 20 mL/hr to run through the duration of the case.
Required Devices and Catheters:
Required Devices and Catheters:
5-F, 10 cm Standard Vascular Sheath
Right femoral venous access
5-Fr Mikaelsson catheter (Merit Medical): dark blue catheter with a white distal portion
5-Fr Cobra-2 catheter (Cook): light blue catheter with a black distal portion
2.8 & 2.4-Fr ProGreat Microcatheter & Fathom micro guidewire
Hole-punching device
Post-Procedure:
Post-Procedure:
One hour after the procedure, call the core lab (chemistry) and confirm the preliminary Cortisol levels (before dilution).
If the preliminary Cortisol level is > 150 ng/dL from both adrenal veins, remove the groin sheath and discharge the patient after hemostasis.
For Discharge:
For Discharge:
None
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