What specialist manages fibromuscular dysplasia (FMD) of bilateral renal arteries?

From the Guidelines

Fibromuscular dysplasia of bilateral renal arteries is typically managed by a vascular specialist, most commonly an interventional radiologist or interventional cardiologist with expertise in renal vascular disease, as recommended in the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The management of fibromuscular dysplasia (FMD) of bilateral renal arteries involves a multidisciplinary approach, including vascular specialists and nephrologists.

• The primary goal is to control blood pressure using antihypertensive medications, particularly ACE inhibitors or ARBs if tolerated.
• For patients with significant stenosis causing refractory hypertension, declining kidney function, or kidney size discrepancy, endovascular intervention with balloon angioplasty may be recommended, as stated in the 2024 ESC guidelines 1.
• Unlike atherosclerotic disease, stents are generally avoided in FMD unless there's a complication during angioplasty.
• Regular follow-up with vascular imaging (typically duplex ultrasound, CTA, or MRA) is essential to monitor disease progression, as recommended by vascular specialists 1.
• Patients should also be screened for FMD in other vascular beds, particularly the cerebrovascular system, as the condition often affects multiple arterial territories. The 2024 ESC guidelines recommend renal artery angioplasty without stenting for patients with hypertension and haemodynamically significant renal artery stenosis due to fibromuscular dysplasia, with a Class IIa and Level C recommendation 1.
• This approach prioritizes the patient's quality of life, morbidity, and mortality, and is supported by the most recent and highest quality study available 1.

From the Research

Specialist Management of Fibromuscular Dysplasia

The management of fibromuscular dysplasia (FMD) of bilateral renal arteries typically involves a multidisciplinary approach, including:

• Interventional radiologists 2
• Vascular surgeons 3
• Nephrologists
• Hypertension specialists

Treatment Options

Treatment options for FMD of bilateral renal arteries include:

• Medical management with antihypertensive drugs
• Endovascular treatment, such as percutaneous transluminal renal angioplasty (PTRA) 4, 5, 2
• Surgical revascularization, such as aortorenal bypass 3

Considerations for Treatment

When considering treatment for FMD of bilateral renal arteries, the following factors should be taken into account:

• Patient age and overall health
• Severity of hypertension and renal impairment
• Presence of other vascular diseases or risk factors
• Technical feasibility of endovascular or surgical treatment 4, 6