Equivalence of the Peripheral Common Trunk and Adrenal Central Vein in Left Adrenal Vein Sampling

PURPOSE: To compare 3 left adrenal vein sampling (AVS) sites-the left adrenal central vein (LCV), the peripheral common trunk (P-CMT), which is near the confluence of the inferior phrenic vein and LCV, and the middle common trunk (M-CMT)-and attempt to identify the reliable site for left AVS. MATERIALS AND METHODS: Consecutive patients with primary aldosteronism who underwent AVS at a general hospital (September 2019 to October 2023) were enrolled. Procedure details and clinical data were collected to analyze the success rates of blood sampling (selectivity index [SI] ≥ 2), aldosterone-to-cortisol (A/C) ratios, and bilateral suppression characteristics. RESULTS: Among the 155 enrolled patients (90 men), both LCV and P-CMT had higher cortisol levels, SI, and success rates than M-CMT (P < .05). No meaningful differences were observed between LCV and P-CMT. In the 126 patients with successful sampling, LCV had higher cortisol levels than P-CMT, but no significant difference was observed in plasma aldosterone concentration (PAC), A/C ratios, and lateralization index (LI). LI cutoffs (≥2 or ≥4) showed no difference in dominant side determination. Pearson analysis confirmed strong correlations in plasma cortisol, PAC, and LI between LCV and P-CMT. Apparent bilateral adrenal suppression rates did not differ significantly between P-CMT and LCV. CONCLUSIONS: The P-CMT is a valid and practical alternative to the LCV for successful left AVS.