Abstract No. 292 Distribution of Interventional Radiology Expertise with Management of Primary Aldosteronism–Related Hypertension

Primary Aldosteronism is the most common cause of secondary hypertension and treatment can be curative. The GU/Renal Subspecialty Council undertook a survey of membership to determine the distribution of centers with expertise in adrenal hypertension in the USA and Canada. Between 7/11/23 and 8/2/23, a survey of adrenal vein sampling and adrenal interventions was performed. performed at the request of the Society of Interventional Radiology GU subspecialty Council. The survey asked respondents to identify Their location, zip code, and whether they do adrenal vein sampling. Of those that do adrenal vein sampling, we asked for details of the adrenal vein practice including members of the adrenal hypertension team, the number of practitioners performing AVS, and the details of the methods used for AVS (whether sampling is simultaneous or sequential, how ACTH stimulation is done, whether cortisol testing is done and how and the make-up of the procedural team). We also asked for estimates of volume and success rate as well as complications and whether experimental procedures like adrenal embolization or ablation were performed. 262 members responded to the survey within the 3 week period of time it was open. Of those 29 did not perform adrenal vein sampling. Of 132 respondents, 81 were from academic practices and 49 were from private practices. Among these respondents, the hypertension team consisted of interventional radiology (96%), endocrinology (73.3%), endocrine surgery (45.8%), and nephrology (41.2%). Cardiology, pathology, and general surgery were less represented. 70% reported sampling the adrenal vein sequentially and only 20% simultaneously. 80% stimulated ACTH and 76% used Cortisol to confirm selection of the adrenal vein. 49.6% of these respondents had chemical pathologists present during adrenal vein sampling procedures. 89% of the time procedures were less than 2 hours with 8.9% lasting up to 3 hours and less than 2% over 3 hours. 81 sites performed < 20 AVS/year with a failure rate of 6.37% and 51 performed >20/year with a failure rate of 1.26%. 41 sites perform adrenal ablation and 52 sites perform adrenal embolization. 25 of these sites were high volume centers. When zip codes were mapped for sites around the US and Canada, the high volume site distribution mimicked population density of the USA and Canada. There is interest among interventional radiologists to perform adrenal vein sampling and there are centers distributed around the population centers of the USA and Canada that can accommodate the needs of patients. Travel distances will be further in the west and correlates with population density.