Xiongjing Jiang

Importance: Femoral vein access used to be the traditional approach for adrenal venous sampling (AVS) procedures, whereas antecubital vein access is the newly developed approach. Until now, no randomized trial for comparison of two approaches has been carried out. Objective: To compare the success rate, safety, and procedural parameters of AVS via an antecubital approach versus femoral approach. Design: This randomized clinical trial (RCT) was conducted between January 2022 and December 2023. The patients with primary aldosteronism (PA) aged 18–60 years were randomly assigned to femoral vein access group (FV) or antecubital vein access group (AV). The intention-to-treat analysis included all randomized patients. Participants: A total of 675 patients aged 18–60 years old with hypertension that were at increased risk for PA were screened, 183 of whom were confirmed with PA. Twenty-nine patients were excluded due to refusal of AVS, decline of participating in this trial, or contraindication to AVS. A total of 154 patients were recruited in this trial. Intervention: Patients were randomly assigned to undergo AVS via femoral approach or antecubital approach. Main outcomes and measures: The primary end point was the success rate of bilateral AVS. Secondary end points included the success rate of right, left sampling, procedure duration, fluoroscopy time, contrast volume, incidence of complications, and postsurgical outcomes. Results: From January 2022 to December 2023, totally 154 patients with PA were randomized to FV group (77cases, mean age, 47.8 ± 8.1 years; 26 females [33.8%]) and AV group (77cases, mean age, 49.2 ± 8.6 years; 30 females [39%]). The baseline characteristics for the two groups were well balanced ( P > 0.05). There were no significant differences in the success rate of bilateral (89.6% vs 92.2%, P = 0.58),right (94.8% vs 97.4%, P = 0.68), and left (94.8% vs 94.8%, P = 1.00) sampling between two groups. The incidence of complications did not differ between the two groups (2.6% vs 0, P = 0.477). The incidence of arterial mis-puncture was significantly higher in FV group than that in AV group (0% vs 9.1%, P = 0.02). The fluoroscopy time and contrast volume did not significantly differ between two groups. The procedure duration in AV group was significantly shorter than that of FV group (18.0 [IQR, 15.0–23.0] versus 20.0 [IQR, 17.0–25.5], P = 0.011). There was no significant difference in the proportion of patients who achieved complete clinical success (50.0% vs 45.9%, P = 0.725) and complete biochemical success (92.1% vs 91.9%, P = 1.000) after adrenalectomy between FV group and AV group. Conclusion and relevance: The trial showed AVS via AV approach or FV approach did not lead to significant differences in success rate and incidence of complications, as well as postsurgical outcomes. However, AV approach was associated with shorter procedure duration, no arterial mis-puncture and earlier ambulation after the procedure, which make it a better alternative to FV approach.

Purpose To compare the feasibility and safety of three approaches for bilateral adrenal venous sampling (AVS) and their influence on the outcomes of adrenalectomy for dominant lateral primary aldosteronism (PA). Methods 182 PA patients who underwent AVS at Fuwai Hospital between January 2022 and March 2024 were enrolled. According to the puncture access, patients were divided into three groups: simultaneous AVS via antecubital approach group (Group A, N = 48), simultaneous AVS via femoral approach group (Group B, N = 44) and sequential AVS via antecubital approach group (Group C, N = 90). The baseline data, procedure parameters, success rates, complication rates and follow-up data were analyzed. Results The baseline characteristics did not differ significantly among three groups (all P > 0.05). The procedure time (18.9 ± 7.4 min vs. 25.2 ± 7.5 min; P < 0.001) and fluoroscopy time (7.1 ± 3.8 min vs. 10.8 ± 6.2 min; P < 0.001) were shorter in Group A than in Group C. However, there was no significant difference between Group A and B (all P > 0.05). The bilateral sampling success rates in Groups A, B and C were 93.8%, 93.2% and 91.1%, respectively, which were not significantly different (P = 0.936). One (0.5%) adrenal haematoma was recorded in Group B. The complete clinical success rate (P = 0.894) and complete biochemical success rate (P = 0.954) were not significantly different in patients with dominant lateralization who underwent adrenalectomy. Conclusion This study revealed that three approaches for AVS are safe and feasible, with similar outcomes after adrenalectomy. Simultaneous AVS via antecubital approach might be a better choice considering its shorter procedure and fluoroscopy time and comfort.

To evaluate the long‐term efficacy and safety of transfemoral access (TFA) versus upper extremity access (UEA) for renal denervation (RDN) based on vascular morphology. This study retrospectively enrolled patients with resistant hypertension who underwent RDN treatment via TFA and UEA (brachial, radial, and ulnar artery) at the Fuwai Hospital between February 2012 and November 2019. Follow‐up was conducted at 6 months, 1 year, and 3 years after RDN, and the last visit was June 2023. A total of 85 patients were enrolled, 58 (68.2%) of them were treated via TFA, and 27 patients (31.8%) via UEA. The fluoroscopy time was less in the TFA group (12.2 ± 5.7 min vs. 15.2 ± 7.2 min; p = 0.038). The procedure time (TFA group: 40.8 ± 14.9 min vs. UEA group: 38.6 ± 11.6 min; p = 0.506), contrast volume (TFA group: 78.2 ± 25.9 mL vs. UEA group: 91.9 ± 39.7 mL; p = 0.061) were similar between two groups, without procedure‐related complications. Fifty‐eight participants completed the last visit with a 3–12 year of follow‐up (9.5 ± 1.3 years). Compared with baseline, there were no significant differences in the change of office systolic blood pressure (−12.6 ± 21.6 mmHg vs. −13.1 ± 22.8 mmHg; p = 0.933), 24‐h mean systolic blood pressure (−11.9 ± 14.2 mmHg vs. −11.3 ± 15.3 mmHg; p = 0.899), the number of antihypertensive drugs, and renal function between two groups. There were three adverse events in the TFA group (3 of 58 patients, 5.2%) versus one (1 of 27 patients, 3.7%) in the UEA group, without a significant difference between the two groups. The study showed RDN via UEA was feasible using a special‐designed catheter, particularly in patients with illegal vascular morphology via TFA.

BACKGROUND: Renal denervation (RDN) can lower blood pressure (BP) in patients with hypertension in both the presence and absence of medication. This is a sham-controlled trial investigating the safety and efficacy of RDN in China. METHODS: This prospective, multicenter, randomized, patient- and outcome-assessor-blinded, sham-controlled trial investigated radiofrequency RDN in patients with hypertension on standardized triple antihypertensive therapy. Eligible patients were randomized 1:1 to undergo RDN using a multi-electrode radiofrequency catheter (Iberis; Shanghai Angiocare Medical Technology, Shanghai, China) or a sham procedure. The primary efficacy outcome was the between-group difference in baseline-adjusted change in mean 24-hour ambulatory systolic BP from randomization to 6 months. RESULTS: Of 217 randomized patients (mean age, 45.3±10.2 years; 21% female), 107 were randomized to RDN and 110 were randomized to sham control. At 6 months, there was a greater reduction in 24-hour systolic BP in the RDN (−13.0±12.1 mm Hg) compared with the sham control group (−3.0±13.0 mm Hg; baseline-adjusted between-group difference, −9.4 mm Hg [95% CI, −12.8 to −5.9]; P P P =0.003) and −5.1 mm Hg ([95% CI, −8.2 to −2.0]; P =0.001), respectively. One patient in the RDN group experienced an access site complication (hematoma), which resolved without sequelae. No other major device- or procedure-related safety events occurred through follow-up. CONCLUSIONS: In this trial of Chinese patients with uncontrolled hypertension on a standardized triple pharmacotherapy, RDN was safe and reduced ambulatory and office BP at 6 months compared with sham. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02901704.

Purpose: Primary aldosteronism (PA) diagnosis is affected by antihypertensive drugs that are commonly taken by patients with suspected PA. In this study, we developed and validated a diagnostic model for screening PA without drug washout. Methods: We retrospectively analyzed 1095 patients diagnosed with PA or essential hypertension. Patients were randomly grouped into training and validation sets at a 7:3 ratio. Baseline characteristics, plasma aldosterone concentration (PAC), and direct renin concentration (DRC) before and after drug washout were separately recorded, and the aldosterone-to-renin ratio (ARR) was calculated. Results: PAC and ARR were higher and direct renin concentration was lower in patients with PA than in patients with essential hypertension. Furthermore, the differences in blood potassium and sodium concentrations and hypertension grades between the two groups were significant. Using the abbreviations potassium (P), ARR (A), PAC (P), sodium (S), and hypertension grade 3 (3), the model was named PAPS₃. The PAPS₃ model had a maximum score of 10, with the cutoff value assigned as 5.5; it showed high sensitivity and specificity for screening PA in patients who exhibit difficulty in tolerating drug washout. Conclusion: PA screening remains crucial, and standard guidelines should be followed for patients to tolerate washout. The PAPS₃ model offers an alternative to minimize risks and enhance diagnostic efficiency in PA for those facing washout challenges. Despite its high accuracy, further validation of this model is warranted through large-scale clinical studies.

Juxtaglomerular cell tumors (JGCTs) or reninoma are rare kidney tumors leading to secondary hypertension, and the non-specific clinical manifestations bring about challenges to the diagnosis. This study is to summarize the clinical features, laboratory findings, and treatment of JGCTs. The PubMed, EMBASE database, and manual search were utilized to find all cases, and 158 reports containing 261 patients were identified. Data on patients’ demographics, clinical features, diagnostic methods, and treatment options were collected and analyzed. JGCTs occurred predominantly in female patients (female to male ratio, 2.1:1). The median age of patients was 25 years (IQR:18–34 years). Hypertension (97.24%) was the cardinal manifestation. Hypokalemia was reported in 78.71% (159/202) of subjects, and normal serum potassium accounted for 20.79% (42/202). In cases with assessed plasma renin activity (PRA) levels, the median PRA was 7.89 times the upper limit of normal (IQR:3.58–14.41), and 3.82% (5/131) of cases in the normal range. Tumors were detected in 97.8% (175/179) computed tomography (CT), 94.7% (72/76) magnetic resonance imaging (MRI), and 81.5% (110/135) ultrasound, respectively. For 250/261 patients undergoing surgical procedures, 89.14% (197/221), 94.94% (150/158), and 100% (131/131) of patients were restored to normal blood pressure, PRA, and serum potassium, respectively. JGCTs are commonly associated with hypertension, hypokalemia, and hyperreninemia, whereas patients with normotension, normokalemia, and PRA should be systematically pursued after drug-elution lasting for 2 weeks. CT and MRI are more sensitive imaging diagnostic methods. The blood pressure and biochemical parameters of most patients returned to normal after surgery.

Yang Chen, Hui Dong, Yu-bao Zou, Xiong-jing Jiang, Piotr Nikodem Rudzínski; Pulmonary artery multifocal stenosis in a young girl with multivessel fibromuscular