Success Rate of Adrenal Venous Sampling and the Location of Right Adrenal Vein Orifice: A Retrospective Study

Adrenal venous sampling (AVS) is the gold standard for identifying aldosterone-producing adenoma and bilateral adrenal hyperplasia. This study reports the success rate of AVS and the distribution characteristics of the right adrenal vein orifice (RAVO). The data of 166 patients with primary hyperaldosteronism who underwent AVS in Fuwai Central China Cardiovascular Hospital were retrospectively reviewed. A single experienced cardiologist with 8 years of experience in cardiovascular intervention performed AVS on the included patients and separately drew 3 mL of blood from each adrenal vein and inferior vena cava. Successful catheterization was confirmed by cortisol ratio (the ratio of the cortisol concentration of each adrenal vein to that of the peripheral vein), and the distribution characteristics of the RAVO were recorded. The success rates of right and left blood samplings were 91.0% and 94.6%, respectively. The success rate of bilateral blood samplings was 86.1%. The success of right blood samplings was higher in patients with a higher body mass index (p = 0.03). The 151 patients whose right blood samplings were successful were divided into five groups according to RAVO location. In 130 (86.1%) of the 151 patients, the RAVO was located at a level ranging from the upper segment of T11 to the lower segment of T12. Age and serum creatinine levels showed statistical significance among the five groups (p = 0.001). These findings provide a practical anatomical roadmap for operators, suggesting that focusing the initial search for the RAVO between T11 and T12, especially in younger and heavier patients, could improve cannulation efficiency and success rates.