From the Guidelines
Percutaneous transluminal renal angioplasty (PTRA) without stenting is the treatment of choice for fibromuscular dysplasia, as it can restore renal perfusion pressure and lower blood pressure. The primary goal of treatment is to manage symptoms, control blood pressure, and prevent complications. According to the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1, medical therapy to reduce blood pressure is the first line of treatment, and PTRA without stenting is recommended for patients with fibromuscular dysplasia.
For patients with severe stenosis causing symptoms or hypertension, revascularization procedures may be necessary, including PTRA for renal or carotid arteries. The 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1 suggests that carotid angioplasty with or without stenting is reasonable for patients with retinal or hemispheric cerebral ischemic symptoms related to FMD of the ipsilateral carotid artery.
Regular monitoring with imaging (typically every 1-2 years) is essential to track disease progression and detect aneurysms, as recommended by the 2011 guideline 1. Lifestyle modifications, including regular exercise, smoking cessation, and maintaining a healthy weight, are also important components of management. The 2013 ACCF/AHA guideline on the management of patients with peripheral artery disease 1 suggests that vascular surgical reconstruction is indicated for patients with fibromuscular dysplastic RAS with clinical indications for interventions, especially those exhibiting complex disease that extends into the segmental arteries and those having macroaneurysms.
Key considerations in the management of fibromuscular dysplasia include:
- Controlling blood pressure to prevent complications
- Monitoring for disease progression and aneurysm detection
- Lifestyle modifications to reduce risk factors
- Revascularization procedures for severe stenosis or symptoms
- Surgical interventions for complex cases or aneurysms larger than 2 cm.
Overall, the treatment of fibromuscular dysplasia should focus on managing symptoms, controlling blood pressure, and preventing complications, with PTRA without stenting as the treatment of choice for eligible patients 1.
From the Research
Treatment Options for Fibromuscular Dysplasia
- The treatment of fibromuscular dysplasia (FMD) may involve a multidisciplinary approach, including catheter-based angiography and percutaneous angioplasty for renal FMD 2.
- A comprehensive review of current literature on FMD management suggests that education and prevention are crucial for patients living with this condition, and a comprehensive multidisciplinary care model is essential given the complexity of the disease 3.
- Systematic and multidisciplinary evaluation of FMD patients can reveal high prevalence of previously undetected FMD lesions and affect clinical decisions, emphasizing the importance of whole-body computed tomography angiography scan 4.
- Endovascular intervention with angioplasty alone is the preferred modality for FMD treatment, although surgical intervention may be necessary in some situations 5.
Multidisciplinary Care Approach
- A multispecialty team approach is recommended for optimal treatment of FMD, considering its potential association with spontaneous coronary artery dissection and other morbid conditions 5.
- Patients with FMD may benefit from panvascular imaging from head-to-pelvis upon diagnosis for screening purposes and targeted imaging surveillance after diagnosis 5.
Note on Fibrous Dysplasia
- It is essential to distinguish between fibromuscular dysplasia and fibrous dysplasia, as the latter is a skeletal disorder with different clinical manifestations and treatment approaches, such as bisphosphonates 6.