Authors' Contributions
primary aldosteronism, fever, hematoma, hypertension, inferior vena cava, hemodilution
PRIMARY ALDOSTERONISM, ALD, HEMATOMA, HYPERTENSION, COMPLICATIONS
Liangdi Xie MD, PhD, and Feng Peng MD, PhD, contributed to conception and design. Zhoufei Fang MD design the study, data reduction, follow-up, statistical analysis, and article writing. Zhoufei Fang is the major AVS operator. Han Cai MD contributed to data reduction and follow-up. Han Cai is also the major AVS operator. All AVS were completed by Zhoufei Fang and Han Cai in this study. Qixiang Zhang MD contributed to follow-up. Jin Gong MD, PhD, improved outpatient screening of hypertension patients. Wei Zhou contributed to native English expression. All authors have contributed to the article and approved the submitted version. Han Cai and Zhoufei Fang contributed equally to this work.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.Techniques of using different catheters in single-path AVS and multipath AVS synchronously and asynchronously. (a) Inserted a 5F MPA catheter into the RAV in the single-path AVS group. (b) Inserted a 5F TIG catheter into the LAV in the single-path AVS group. Angiogram showed a thick common trunk vein formed by the confluence of the LAV and the PV. (c) To avoid local hemodilution of the LAV, a microcatheter was used to superselect into the LAV. Angiogram showed that the microcatheter superselected into the LAV. (d) 5F MPA catheter synchronously embedded in the RAV opening and in the LAV opening in the multipath AVS. (e) In anteroposterior position, intubated RAV through the cubital vein with a TIG catheter. (f) In right anterior oblique 30° angiography, the central venous opening of RAV was right oblique toward the III quadrant. (g) In anteroposterior position, intubated RAV with a MPA catheter via the femoral vein. (h) In right anterior oblique 30° angiography, the central venous opening of RAV was direct toward the III quadrant. Figures (e–h) show adrenal venography in the same patient in different positions. Figures (g, h) show that MPA catheter got through the femoral vein pathway and accurately positioned to the RAV with a total exposure time of 12.77 min. Figures (e, f) show that TIG catheter got through the cubital vein pathway, reaching the RAV with a total exposure time of 6.45 min. AVS: adrenal vein sampling; LAV: left adrenal vein; RAV: right adrenal vein; LRV: left renal vein; IVC: inferior vena cava; IEV: inferior emissary vein; PV: phrenic vein.Characteristics of baseline data between single-path group and multipath group with primary aldosteronism patients receiving AVS.SBP: systolic blood pressure; DBP: diastolic blood pressure; LDL: low-density lipoprotein cholesterol; ALD: serum aldosterone; DRC: serum renin concentration; ARR: aldosterone-to-renin ratio. Age was calculated in years from birthdate to date of informed consent.Parameters and complications of AVS.Success rate of right- or left-side intubation, vascular dissection, fever, and hematoma using correction Relationship of catheter selection and right adrenal vein opening axial position.
