Comparison of three approaches for adrenal venous sampling in patients with primary aldosteronism

Purpose To compare the feasibility and safety of three approaches for bilateral adrenal venous sampling (AVS) and their influence on the outcomes of adrenalectomy for dominant lateral primary aldosteronism (PA). Methods 182 PA patients who underwent AVS at Fuwai Hospital between January 2022 and March 2024 were enrolled. According to the puncture access, patients were divided into three groups: simultaneous AVS via antecubital approach group (Group A, N = 48), simultaneous AVS via femoral approach group (Group B, N = 44) and sequential AVS via antecubital approach group (Group C, N = 90). The baseline data, procedure parameters, success rates, complication rates and follow-up data were analyzed. Results The baseline characteristics did not differ significantly among three groups (all P > 0.05). The procedure time (18.9 +/- 7.4 min vs. 25.2 +/- 7.5 min; P < 0.001) and fluoroscopy time (7.1 +/- 3.8 min vs. 10.8 +/- 6.2 min; P < 0.001) were shorter in Group A than in Group C. However, there was no significant difference between Group A and B (all P > 0.05). The bilateral sampling success rates in Groups A, B and C were 93.8%, 93.2% and 91.1%, respectively, which were not significantly different (P = 0.936). One (0.5%) adrenal haematoma was recorded in Group B. The complete clinical success rate (P = 0.894) and complete biochemical success rate (P = 0.954) were not significantly different in patients with dominant lateralization who underwent adrenalectomy. Conclusion This study revealed that three approaches for AVS are safe and feasible, with similar outcomes after adrenalectomy. Simultaneous AVS via antecubital approach might be a better choice considering its shorter procedure and fluoroscopy time and comfort.