Success Rate and Safety of Adrenal Venous Sampling via the Antecubital Approach: A Systematic Review and Meta-Analysis.

OBJECTIVE

This meta-analysis aimed to evaluate the success rate and safety of adrenal venous sampling (AVS) via the antecubital approach and to compare these outcomes with the femoral approach.

METHODS

A systematic search was performed in PubMed, Embase, Cochrane Library, Web of Science, and Wanfang Data from inception to May 1, 2025. The primary outcome was the success rate of right and left adrenal vein cannulation. Secondary outcomes included procedure-related complications, fluoroscopy time, and contrast agent volume. Comparative outcomes were reported as odds ratios (ORs) and weighted mean differences (WMDs).

RESULTS

A total of 11 studies involving 2332 patients with primary aldosteronism undergoing AVS were included. The antecubital approach for AVS showed no statistically significant differences compared with the femoral approach in right adrenal vein cannulation success rate (antecubital single-arm pooled estimate: 91.9%, 95% CI: 85.26% to 95.70%; comparative analysis: OR 1.43, 95% CI: 0.23-9.04), left adrenal vein cannulation success rate (95.35%, 95% CI: 94.34% to 96.19%; OR 1.44, 95% CI: 0.63-3.28), procedure-related complications (0.36%, 95% CI: 0.07% to 0.79%; OR 0.51, 95% CI: 0.17-1.60), fluoroscopy time (7.64 minutes, 95% CI: 6.12-9.16; WMD 0.62 minutes, 95% CI: -0.75 to 1.99), or contrast agent volume (19.37 mL, 95% CI: 15.9-22.83; WMD 0.19 mL, 95% CI: -0.57 to 0.96).

CONCLUSION

Antecubital AVS demonstrated acceptable success rates and safety, particularly in moderate- to high-volume centers, without clear inferiority to the femoral approach.