Do you have high blood pressure? Maybe you're having trouble controlling your blood pressure even after taking several medications prescribed by your doctor. In times like these, it could be because of a change in the function of two small glands inside your body. Today, we're talking about a specialized test called Adrenal Venous Sampling, or AVS, which is a test that can help you find out exactly what's causing your blood pressure.
What is Adrenal Venous Sampling (AVS)?
Simply put, AVS is a test that checks to see if one or both of your adrenal glands are producing too much hormone. These glands are located above our kidneys, like two hats.
One important hormone produced by these glands is called aldosterone . This hormone is very important for maintaining the balance of blood pressure and electrolytes in the body. However, if this aldosterone hormone is secreted too much, your blood pressure can increase and your blood potassium levels can decrease.
In an AVS test, an interventional radiologist injects a special dye into the veins that connect your adrenal glands and takes two blood samples from those veins. These two blood samples are then tested to see if the aldosterone is coming from the right gland, the left gland, or both. Your doctor will use these results to decide what treatment to give you next.
Why do you need to do this AVS test?
This test is often recommended when you are suspected of having a condition called Primary Aldosteronism (Conn's Syndrome) , which is a condition caused by the overproduction of the hormone aldosterone.
Imagine, your water tank is overflowing. When you go to find the cause, you find that one or both of the two pipes that supply water are leaking. The AVS test is exactly like that. It is used to find out exactly whether the problem is in one gland or in both.
This way, when you know exactly where the problem is, it's much easier to decide on treatment. Sometimes this test is also used to detect conditions like pheochromocytoma, a rare tumor that forms in the adrenal gland.
How should I prepare for this test?
AVS is an outpatient procedure that is performed in a hospital or operating room. You will be awake during the procedure, but you will not feel any pain. This is because it is performed using a local anesthetic and sometimes a conscious sedation to calm you down and put you into a light sleep.
If you are given a light sedative, it is essential that someone is there to take you home after the test.
Also, your doctor may ask you to stop taking certain medications a few days before the test. Therefore, inform your doctor about all medications you are taking. You will need to fast the morning of the test.
What happens during the test?
This is what happens during the test:
- First, a cannula (IV line) will be placed in a vein in your arm, through which a medicine that stimulates your adrenal glands will be given. If you are given a medicine to calm you down, it will also be given through this.
- Then, your groin area where the catheter (thin tube) is inserted will be numbed so you won't feel any pain.
- The specialist makes a small incision in the skin of the groin and inserts the catheter through it. They use an ultrasound scan to find the exact vein.
- Next, a special liquid (contrast material) is inserted through this catheter, and with the help of an X-ray, the catheter is guided to the veins of your adrenal glands.
- Once the veins are located, a small blood sample is taken from both the right and left adrenal veins.
- Finally, the catheter is removed and a bandage is placed over the incision.
Does this hurt?
No, it doesn't hurt. You won't feel any pain because it's numb. Some people say that when the special liquid goes through the veins, it feels like a little heat. But that goes away in a few seconds.
What do the results say?
After sending the blood sample to the lab and testing it, your doctor can tell you exactly where the problem lies.
- If only one adrenal gland is producing excess aldosterone, surgical removal of that gland (adrenalectomy) may be recommended.
- If both glands produce too much aldosterone, the best treatment is usually medication.
Your entire treatment plan will depend on this result.
What are the risks of this test?
AVS is a largely safe and successful test, but as with any medical procedure, there are some minor risks.
| Risk | A simple explanation |
|---|---|
| Bleeding | Bleeding can occur due to damage to a vein, but this is very rare. |
| Infection | There is a very small chance of infection through the skin incision where the catheter is inserted. |
| Allergic Reaction | It is also very rare to have an allergy to the contrast fluid used. |
| Kidney damage | If you already have kidney disease, the risk may be slightly increased by the contrast fluid. |
| Vein Rupture | The vein may be damaged when the catheter is inserted. If this happens, the test will need to be done on another day. |
Recovery time and when to see a doctor
It may take several days to fully recover from an AVS test. It is important to get plenty of rest during this time. If you return to your normal activities too soon, complications such as bleeding from the incision site may occur.
Your doctor may advise you to avoid the following for about 3 days:
- Driving.
- Operating heavy machinery.
- Weight lifting.
- Exercising or doing strenuous work.
- Things like getting in a bathtub, swimming, etc.
- Signing legal documents (due to medication that makes you drowsy).
If you have these symptoms, call your doctor immediately.
If any of the following symptoms appear after the test, inform your doctor without delay.
- Bleeding from a cut in the groin.
- If the pain is getting worse.
- Fever.
- Nausea or vomiting.
The AVS test may seem a bit complicated to you, but it's the best way to know for sure if your high blood pressure is caused by your adrenal glands. So be open about any questions, concerns, or doubts you have about this with your doctor.
Take-Home Message
- Adrenal Venous Sampling (AVS) is a special test that detects which adrenal gland produces the most aldosterone hormone, which causes high blood pressure.
- This is done with numbing medication so you don't feel any pain.
- Depending on the results of the test, your doctor will be able to determine whether surgery or medication is the best treatment for you.
- It is very important to rest for a few days after the test.
- Never hesitate to discuss any concerns or fears you have in this regard with your doctor.
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