Arterial-venous adrenal embolization for aldosterone adenoma: a preliminary exploratory study.

Adrenalectomy is the curative treatment for aldosterone-producing adenoma (APA), yet many patients are unable or unwilling to undergo surgery. Selective adrenal arterial embolization (SAAE) has been explored as a minimally invasive alternative, but its efficacy is limited by incomplete arterial occlusion. This study aimed to evaluate the efficacy and safety of a novel technique-selective adrenal arterial and venous embolization (SAAVE)-which combines arterial and venous occlusion to enhance hormonal suppression in APA. We prospectively enrolled patients with left-sided APA undergoing SAAVE. The primary endpoint was the change in plasma aldosterone concentration (PAC) at 3 months. For comparison, 40 patients who previously received SAAE were retrospectively analyzed, and propensity score matching (PSM) was performed to adjust for baseline differences. A total of 11 SAAVE and 40 SAAE patients were included. At 3 months, SAAVE markedly reduced PAC (-65.17 ± 52.63 ng/dL, P = 0.002), normalized serum potassium, and significantly lowered 24-h ambulatory blood pressure (ΔSBP -16.91 ± 20.16 mmHg; ΔDBP -9.55 ± 12.19 mmHg). No major adverse events occurred, and cortisol levels remained stable. Compared with SAAE, SAAVE achieved a higher rate of complete biochemical remission (81.8% vs 35.0%, P = 0.014), a difference that remained significant after PSM (81.8% vs 45.4%, P = 0.030). SAAVE achieved effective biochemical correction and satisfactory blood pressure control without compromising safety. These findings provide early evidence that combining arterial and venous embolization may offer a minimally invasive option for patients with left-sided APA who are not candidates for surgery.