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Case Reports
. 2019 Apr 30;1(1):28-31.
doi: 10.19779/j.cnki.2096-3602.2018.01.07. eCollection 2018 Feb.

Arterial stimulation with simultaneous venous sampling for localizing insulinomas

Zhiyuan Wu  1 , Tingwei Su  2 , Daming Wu  3 , Xiaoyi Ding  1 , Zhongmin Wang  1 , Wei Huang  1 , Ziyin Wang  1 , Qin Liu  1 , Hua Zhang  3
Affiliations
Case Reports

Arterial stimulation with simultaneous venous sampling for localizing insulinomas

Zhiyuan Wu et al. J Interv Med. .

Abstract

Purpose: The present study aimed to assess the accuracies of arterial stimulation with simultaneous venous sampling (ASVS) in preoperative localization of insulinomas. Materials and Methods: A cohort consisting of 6 males and 14 females (median age, 48.5y; range, 28-62y) with pathologically proven insulinomas were included in this study. Selective angiographies were performed with the superior mesenteric artery (SMA), gastroduodenal artery (GDA), proximal splenic artery, and midsplenic artery in all individuals. Then ASVS procedures were followed after angiographies for these arteries. Clinical characteristics of the patient and the tumor number, location, and size were recorded. The accuracy of preoperative localization of insulinomas was tested. Results: A total of 22 tumors were identified by histopathological diagnosis. The mean size of the tumor was 1.40±0.60cm. Five tumors were in the head/neck region and 17 in the body/tail region. ASVS accurately localized 17/20 (85%) cases with only biochemical data and 19/20 (95%) cases with biochemical data and angiography images. Variant pancreatic arterial anatomy was revealed in 2 false cases with inferior pancreatic artery replaced by the superior mesenteric artery. Conclusion: ASVS was highly accurate in localizing insulinomas and should be performed in most of the patients with suspected insulinomas before the operation.

Keywords: arterial stimulation with simultaneous venous sampling; insulinomas; localization diagnosis.

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Figures

Figure 1.
Figure 1.
Angiography and ASVS results of one case. (a) The vascular tumor blush was seen in the body/tail region (arrow). (b) Insulin level increased 2.29-fold after calcium injection at the dominant artery (midsplenic artery) as predicted by the body/tail lesion.
Figure 2.
Figure 2.
ASVS in the presence of variant pancreatic arterial anatomy. (a) Angiographic imaging revealed an oval vascular tumor blush in the body/tail region of the pancreas (arrow). The blood supply was from IPA that was replaced by SMA. (b) Insulin level increased 7.04-fold after calcium injection at the dominant artery (SMA) as predicted by the head/neck lesion.
See this image and copyright information in PMC

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