No abstract

Objectives: This study aimed to assess the safety, blood pressure changes, and biochemical responses of superselective adrenal artery embolization (SAAE) in hypertensive patients with idiopathic hyperaldosteronism (IHA).Background: SAAE is a minimally invasive procedure that has been used to successfully treat aldosterone-producing adenoma. However, its effect for patients with IHA is unevaluated.Methods: A total of 41 hypertensive patients who were diagnosed with IHA and underwent SAAE at the Fuwai Hospital between December 2010 and June 2016 were prospectively enrolled. The blood pressure, antihypertensive medications, plasma aldosterone and potassium levels, and adverse events were assessed. The primary endpoint was the change in home blood pressure at 12 months, compared with baseline.Results: SAAE was technically successful in 39 patients. Postoperatively, home and 24-hr mean blood pressures were reduced by 14/9 and 10/7 mmHg at 1 month, respectively, and by 13/7 and 11/7 mmHg at 12 months, respectively. The number of antihypertensive agents used reduced by 1.0 and 1.1 at 1 month and 12 months, respectively (all p < .001). Compared with baseline (524.0 pmol/L), the standing plasma aldosterone reduced to 293.4 pmol/L at 12 months (p < .001). Serum potassium increased from 3.0 to 4.1 mmol/L while the rate of potassium supplement and mineralocorticoid receptor antagonist use reduced from 87.1 and 89.7%, respectively, to 28.2 and 17.9%, respectively, at 12 months (all p < .001). There were no serious complications in the perioperative and 12-month follow-up periods.Conclusions: SAAE was effective and feasible for IHA treatment, without serious complications, therefore, maybe a potential treatment.

Multidetector computed tomography angiography was a more sensitive and specific technique for the diagnosis of DCA compared with CAG.

Purpose Adrenal venous sampling (AVS) is considered as the gold standard for differentiating unilateral and bilateral forms of primary aldosteronism. Currently, almost all AVS procedures are performed via femoral vein access. The aim of this study was to evaluate the success rate and safety of AVS via an antecubital approach. Methods In a retrospective multicenter study involving 7 Chinese medical centers, patients with primary aldosteronism underwent AVS via an antecubital approach between January 2012 and December 2018 were analyzed. Successful sampling was determined by selectivity index (cortisol in the adrenal vein/cortisol in inferior vena cava) &gt;2. Results A total of 1226 participants (mean age, 47.1 years; 57.9% male) were included. The puncture site was right and left antecubital vein in 1211(98.8%), and 15(1.2%) patients. The access of 6 patients (0.5%) was changed to right femoral vein due to the failure of antecubital vein cannulation or anatomic variation of adrenal vein. The success rate of bilateral, right and left sampling was 91.5%, 94.9% and 95.1%, respectively. The success rate of bilateral, right, left sampling increased from 82.9% ,87.1% and 88.6% during the initial 70 cases (total of initial 10 cases each center) to 92.0% (P=0.012), 95.3% (P=0.008) and 95.5% (P=0.018) with subsequent cases. Adrenal vein rupture occurred in 5 patients (0.46%), with no sequelae. Conclusions The multicenter study demonstrated that AVS via an antecubital approach was safe and feasible, with a high rate of successful sampling, which may be an alternative to the femoral vein access method.