Yasutaka Baba MD, Presenter: Nothing to Disclose

Sadao Hayashi MD, Abstract Co-Author: Nothing to Disclose

Kohei Nagasato, Abstract Co-Author: Nothing to Disclose

Takashi Yoshiura MD, PhD, Abstract Co-Author: Nothing to Disclose

To investigate the efficacy of endovascular treatment for aldosterone producing adrenal adenoma (APAA) including the long term results.  

We retrospectively analyzed treatment results of 42 APAAs in 42 consecutive patients (12 male and 30 females; mean age, 47 years) that were treated by endovascular treatment (arterial or venous embolization) with absolute ethanol (AE) between August 1992 and June 2013. 25 adenomas were located in the right adrenal gland while 17 were in the left. The mean size of the adenomas was 14mm (range, 8-30 mm) in diameter. Before embolization, we mapped all feeding arteries of the adenoma. Then we determine the volume of AE to use for embolization by adrenal arteriograms or CT images. Prophylactic microcoil embolization of distal feeding arteries was performed in order to avoid unintentional AE injection. In venous embolization, a balloon catheter was used to avoid the reflux of AE. In order to prevent pain and vascular spasm during arterial embolization, we injected lidocaine into the feeding arteries. In addition, we used anti-alpha blocker and calcium blocker to prevent hypertension and hypercatecholaminemia. We evaluated the technical success rate which was defined as normal range of both serum aldosterone concentration and renin activity within 1 month after treatment and acute complications. Moreover, we evaluated rates of improvement in hypertension and normalization of serum aldosterone concentration and renin activity in the follow-up period. The mean follow-up period was 1309 days.

The number of treatment session was 56 and average dosage of AE was 1.8 mL. (range, 0.2-7 mL). Technical success rate was 88% (37/42) and five patients were subsequently treated by operation. Acute complication comprised of pain (64%), unstable blood pressure (23%) and pleural effusion (11%) without major complications. Rates of improvement in hypertension, normalization of serum aldosterone concentration and renin activity in the follow-up period were 72% (27/37), 97% (36/37), and 97% (36/37), respectively.  

Endovascular treatment is less invasive and efficient therapeutic option for APAAs.

Endovascular embolization of APAA is a promising treatment option.

Baba, Y, Hayashi, S, Nagasato, K, Yoshiura, T, Endovascular Treatment for Aldosterone Producing Adrenal Adenoma: A Long Term Follow-up Study.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001974.html