Improving Success Rate and Safety of Adrenal Venous Sampling: A Comparison of Three Approaches and Personalized Selection Strategies

Objective To evaluate the feasibility and safety of adrenal venous sampling (AVS) via three different approaches, and to assess its value in predicting the outcome of laparoscopic adrenalectomy. Methods A retrospective analysis was conducted on 302 patients with primary aldosteronism (PA) who underwent AVS at the First Affiliated Hospital of Fujian Medical University between January 2021 and January 2026. Based on the sampling access route, patients were divided into three groups: the single right antecubital venous approach group (SA, n = 92), the dual right antecubital venous approach group (DA, n = 104), and the combined right antecubital and right femoral venous approach group (AF, n = 106). The success rate of blood sampling, catheter selection, fluoroscopy duration, complications, and clinical and biochemical remission after laparoscopic surgery were compared among the three groups. Results Baseline characteristics showed no statistically significant differences among the three groups ( P  > 0.05). Regarding blood sampling success rates, both the DA and AF groups demonstrated significant improvement compared to the SA group (90.38%/91.51% vs. 71.74%, P  < 0.001). Fluoroscopy time was significantly shorter in the DA and AF groups than in the SA group (12.09 ± 2.90 min / 8.54 ± 2.63 min vs. 15.83 ± 3.53 min, P  < 0.001), with the AF group showing the shortest time among all three groups ( P  < 0.001). In terms of complications, the AF group had a higher incidence of puncture site complications compared to the DA group (10.38% vs. 5.77%), though the difference was not statistically significant ( P  > 0.05). Catheter selection for right adrenal venous sampling was more diverse in the AF group than in the DA group ( P  < 0.001). No statistically significant differences were observed among the three groups in postoperative clinical remission rates or biochemical remission rates ( P  > 0.05). Conclusion The dual right antecubital and the combined antecubital-femoral approaches are both effective and safe AVS techniques, outperforming the single-access approach. The combined antecubital-femoral approach achieves the shortest fluoroscopy time and offers the highest operational efficiency. Successful AVS performed via any of the three approaches can provide reliable evidence for laparoscopic adrenalectomy.