Comparative Analysis of Single-Path and Multipath Adrenal Venous Sampling in Primary Aldosteronism

Figure 1

Flow diagram for diagnosis and grouping of PA patients. Defined the intersection of RAV and IVC as the origin and established a plane coordinate system. In digital subtraction angiography (DSA) images, the RAV opening located on 0–3 o’clock direction was the first quartile (I) and 3–6 o’clock direction was the third quadrant (III) according to clock wise notation. (a) DSA image showed a MPA catheter embedded in the RAV opening, with the adrenal vein opening towards the I quadrant. (b) DSA image showed the central RAV entering the IVC in the III quadrant, which was defined as group III. A TIG catheter embedded in the RAV. (c) DSA image showed 5F MPA catheter embedded in the RAV opening and in the LAV opening, respectively, and synchronously. (d) The RAV could not be reached by repeated use of MPA and TIG catheter through single-path AVS via the cubital vein. A TIG catheter was used to reach the RAV, which was shown to open in the III quadrant on angiography. PA: primary aldosteronism; AVS: adrenal venous sampling; DRC: direct renin concentration; ARR: aldosterone-to-renin ratio; RAV: right adrenal vein; LAV: left adrenal vein; IVC: inferior vena cava.