Feasibility and Safety Clinical Study of a Novel Technique for Simultaneous Bilateral Adrenal Vein Sampling via Right Elbow Venous Access: A Prospective Clinical Study.

OBJECTIVES

Bilateral adrenal venous sampling (AVS) is critical for accurate primary aldosteronism (PA) subtype differentiation and treatment planning; however, its complexity and invasiveness limit its widespread adoption. We tested a less invasive simultaneous bilateral AVS via right cubital vein using 2 4F MPA1 catheters to improve practicality/safety.

METHODS

Single-center feasibility study of 85 PA patients was enrolled from August 2024 to June 2025. Procedures were guided primarily by computed tomography (88.23%) and ultrasound (41.18%), with careful documentation of procedural specifics, including patient demographics, anatomical variations of the right adrenal central vein, and outcomes such as success rates and complications.

RESULTS

The 85 enrolled patients had a uniform age and gender distribution. 88.23% of patients with PA underwent computed tomography assessment of adrenal vein anatomy prior to AVS, while 41.18% of patients with PA underwent ultrasound examination of the elbow vein during AVS. Right adrenal central vein anatomical variants were categorized, with Type I being most common (60.81%). The novel AVS method achieved a remarkable success rate of 97.53% (79/81). In these cases, 59.49% (47/79) exhibited dominant aldosterone secretion, informing further treatment strategies. A single instance (1.18%) of post-procedural adrenal vein hematoma was noted.

CONCLUSIONS

The implementation of simultaneous bilateral AVS through the right cubital vein using specialized catheters significantly simplifies the procedure, increases surgical success, and reduces patient trauma. The high success rate, coupled with a low complication incidence, underscores the technique's safety, feasibility, and substantial clinical implications, suggesting broad applicability for improved PA management.