Adrenal Venous Sampling Via an Antecubital Approach in Primary Aldosteronism: A Multicenter Study

Abstract

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) >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.

Successful Superficial Blood Sampling to Localize a Fibroblast Growth Factor-23-Producing Tumor

“…Adrenal vein sampling (AVS) is a popular method for confirming the laterality of aldosterone production [ 10 , 15 , 23 ].…”

“…This procedure has also been applied to diagnose other diseases, such as cavernous sinus sampling for Cushing’s disease [ 7 ], selective arterial secretagogue injection (SASI) test for functional pancreatic neuroendocrine tumors [ 8 , 9 ], adrenal vein sampling for primary aldosteronism [ 10 ], ovarian vein sampling for sex hormone-producing ovarian tumors [ 11 – 13 ], and parathyroid hormone sampling for hyperparathyroidism [ 14 ]. Despite the diagnostic usefulness of systemic venous sampling, the procedure requires specialized skills and equipment and carries the risk of critical adverse events [ 10 , 15 , 16 ]. Consequently, venous sampling procedures are conducted within specialized institutions and are reserved for specific patient cases.…”