Safety and feasibility of unilateral double femoral venous access including double sheath insertion via a single-hole method for adrenal venous sampling

Purpose To assess the safety and feasibility of unilateral double femoral venous access including double sheath insertion via a single-hole method (two-in-one method) for adrenal venous sampling (AVS). Materials and methods Two 5-Fr sheaths were percutaneously inserted into a single femoral vein for AVS in 324 patients. Two needles were inserted sequentially in tandem under ultrasound guidance; furthermore, two sheaths were individually inserted (two-in-two method) if both punctures were successfully achieved. In the presence of a single puncture, two sheaths were inserted through two guidewires and a temporarily inserted sheath (two-in-one method). This protocol was repeated until two sheaths were successfully inserted. Thus, two sheaths were inserted with the two-in-one method in 56 patients (17.3%) and two-in-two method in 268 patients (82.7%). Results No significant differences in the technical success rates of AVS were observed (p = 0.067-0.647). Minor groin hematoma was observed more frequently in the two-in-one than in the two-in-two method (8.9% vs. 2.6%, p = 0.039). No major groin hematoma, deep venous thrombosis, or pulmonary embolization was observed. The mean number of needle puncture was 2.5 +/- 1.3 and duration of inserting two sheaths 5.1 +/- 3.9 min. Conclusion Unilateral double femoral venous access including the two-in-one method is safe and feasible for AVS.