Primary aldosteronism (PA) affects 5%–10% of all patients with hypertension. About half of these patients have unilateral disease that can be cured with adrenalectomy. Although adrenal vein sampling (AVS) is crucial for identifying unilateral PA, it is operator dependent and technically difficult. While excellent AVS rates have been reported in high-volume specialized centers, most other institutions worldwide have cannulation rates as low as 31%–61%, leading to missed opportunities to cure. While surgery ameliorates the risk of cardiovascular disease, atrial fibrillation and death, patients treated with medications remain at an increased risk of complications, further highlighting the importance of identifying unilateral PA. At our institution, we reviewed our AVS practice and incorporated several strategies in our program to improve AVS rates. We herein report the success rates of our AVS program, which was initiated in 2015. We also suggest practical measures that can be adopted by other low-volume centers worldwide to achieve similar success.
