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. Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic vascular disease that affects multiple vascular beds, including the renal and carotid arteries, and can lead to significant morbidity and mortality if left untreated 1. The condition is characterized by abnormal cell growth in artery walls, resulting in narrowing, aneurysms, or tears, and can present with symptoms such as hypertension, headaches, pulsatile tinnitus, stroke, or be completely asymptomatic.
Key Considerations
- Patients with FMD should receive medical therapy to reduce blood pressure in the first instance, and PTRA without stenting is recommended for those with significant artery narrowing causing symptoms or uncontrolled hypertension 1.
- Regular vascular imaging surveillance is crucial to identify all affected vessels and aneurysms, and to monitor disease progression.
- Lifestyle modifications, including smoking cessation and regular exercise, are important components of care, and can help improve quality of life and reduce the risk of complications.
- Genetic factors likely play a role in FMD development, though specific genes have not been definitively identified, and further research is needed to understand the underlying causes of the condition.
Management and Treatment
- Antiplatelet therapy, such as aspirin 81-325 mg daily, may be recommended to prevent clotting complications, and blood pressure control is essential to reduce the risk of cardiovascular events.
- Comprehensive vascular imaging at diagnosis is necessary to identify all affected vessels and aneurysms, and to guide treatment decisions.
- Patients with FMD should be closely monitored for signs of disease progression, and treated promptly if symptoms or complications arise, to improve morbidity, mortality, and quality of life outcomes.
From the Research
Definition and Prevalence of Fibromuscular Dysplasia
- Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory arteriopathy that can affect all vascular beds, resulting in arterial stenosis, occlusion, aneurysm, or dissection 2.
- FMD is more frequent and often systemic than previously thought, and can have devastating consequences if left untreated 3.
- The majority of FMD patients are women, but men may have a more progressive disease, especially when smoking 4.
Clinical Manifestations and Diagnosis
- Clinical manifestations of FMD often reflect the vascular territory affected, and can include hypertension, headaches, pulsatile tinnitus, myocardial infarction, transient ischemic attack, and stroke 2.
- The gold standard for diagnostic evaluation of FMD remains catheter-based angiography, but noninvasive imaging such as duplex ultrasound, computed tomographic angiography, and magnetic resonance angiography may be used for diagnosis 2.
- FMD lesions can be found in various arteries, including renal arteries (87.5%), cerebrovascular (24.6%), mesenteric (13.8%), and upper (3.0%) and lower extremity (9.9%) arteries 5.
Management and Treatment
- Treatment of FMD depends on symptoms as well as the nature and location of arterial lesions, and may include both medical (blood pressure control, antiplatelet agents) and interventional (angioplasty, stents, coils, surgery) therapies 2.
- The management of FMD depends on the vascular phenotype as well as the clinical picture, and ongoing research will elaborate on the current progress in improved understandings of the disease's clinical manifestations, epidemiology, natural history, and pathogenesis 4.
- Percutaneous revascularization based on hemodynamic assessment with a pressure measurement guidewire can be an effective treatment for FMD patients with renal artery stenosis and hypertension 6.