Fibromuscular dysplasia - Revision history

Aidan: /* FMD of the extremities */

2025-01-02T21:56:42Z

FMD of the extremities

← Older revision		Revision as of 21:56, 2 January 2025
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	* Can cause mesenteric ischemia		* Can cause mesenteric ischemia

	=== FMD of the ~~extremities~~ ===		=== FMD of the Extremities ===

	* Most commonly the external iliac arteries, though can involved brachial arteries as well		* Most commonly the external iliac arteries, though can involved brachial arteries as well

Aidan at 17:55, 15 October 2021

2021-10-15T17:55:01Z

← Older revision		Revision as of 17:55, 15 October 2021
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	== ~~Differential Diagnosis~~ ==		== Background ==
			* Non-inflammatory, non-atherosclerotic fibroplastic disorder

			*Far more common in women (90% of cases)
⚫	* Standing waves caused by contrast-induced spasm
⚫	* Atherosclerosis
⚫	* Vasculitis
⚫	* Segmental arterial mediolysis

	== Clinical Manifestations ==		== Clinical Manifestations ==
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	** Other arteries including iliac and intracranial 10%		** Other arteries including iliac and intracranial 10%

	=== Renal ~~artery~~ FMD ===		=== Renal Artery FMD ===

	* Hypertension, especialy early-onset <35 years or drug-resistant		* [[Hypertension]], especialy early-onset <35 years or drug-resistant
	** Average age of onset 43 years		** Average age of onset 43 years
	* Epigastric or flank bruit		* Epigastric or flank bruit
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	* May have a lower abdominal or inguinal bruit		* May have a lower abdominal or inguinal bruit

	=== FMD of the ~~coronary~~ ~~arteries~~ ===		=== FMD of the Coronary Arteries ===

	* Can present as an acute coronary syndrome, though rare		* Can present as an acute coronary syndrome, though rare

			== Differential Diagnosis ==

		⚫	* Standing waves caused by contrast-induced spasm
		⚫	* [[Atherosclerosis]]
		⚫	* [[Vasculitis]]
		⚫	* Segmental arterial mediolysis

	== Diagnosis ==		== Diagnosis ==

	* CT or MR angiography or Duplex ultrasound		* CT or MR angiography (or Duplex ultrasound, if CT unavailable)
			**Measures a gradient
			*Previously would use captopril renal scan

	== Management ==		== Management ==

	=== Renal ~~artery~~ ~~revascularization~~ ===		=== Renal Artery Revascularization ===

			* Recurs in 50-60%

	==== Indications ====		==== Indications ====
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	=== Chronic ===		=== Chronic ===

			* Low-dose ASA recommended for all patients

	==== Screening ====		==== Screening ====

	* All patients with FMD anywhere are recommended to be screened for intracranial aneurysms with CTA or MRA		* All patients with FMD anywhere are recommended to be screened for intracranial aneurysms with CTA or MRA
			*Carotid, coronary, vertebral aneurysms all possible, so likely useful to do whole-body CTA

	==== Hypertension ====		==== Hypertension ====

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-22T10:16:21Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 10:16, 22 July 2020
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	* Segmental arterial mediolysis		* Segmental arterial mediolysis

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Arteries involved:		* Arteries involved:

Maintenance script: Imported from text file

2020-07-04T01:17:34Z

Imported from text file

New page

== Differential Diagnosis ==

* Standing waves caused by contrast-induced spasm
* Atherosclerosis
* Vasculitis
* Segmental arterial mediolysis

== Clinical Presentation ==

* Arteries involved:
** Renal 58%
** Carotid or vertebral 32%
** Other arteries including iliac and intracranial 10%

=== Renal artery FMD ===

* Hypertension, especialy early-onset <35 years or drug-resistant
** Average age of onset 43 years
* Epigastric or flank bruit
* Flank pain if dissection or aneurysm
* Progression to end-stage renal disease is rare

=== Cerebrovascular FMD ===

* Headache is most common complaint, usually migrainous
* Pulsatile tinnitus
* Dizziness or lightheadedness
* Cervical bruit
* Neck pain
* TIA or stroke
* Carotid and vertebral artery dissections, presenting with headache and neck pain, cranial nerve deficits, or Horner syndrome
* Can cause cerebral aneurysms

=== Mesenteric FMD ===

* Rare, often incidental finding
* Can cause mesenteric ischemia

=== FMD of the extremities ===

* Most commonly the external iliac arteries, though can involved brachial arteries as well
* Often asymptomatic, or claudication; rarely, acute ischemia
* May have a lower abdominal or inguinal bruit

=== FMD of the coronary arteries ===

* Can present as an acute coronary syndrome, though rare

== Diagnosis ==

* CT or MR angiography or Duplex ultrasound

== Management ==

=== Renal artery revascularization ===

==== Indications ====

* Resistant hypertension despite 3-drug regimen including diuretic
* Recent-onset hypertension, with the goal of curing it
* Renal artery dissection (needs stenting)
* Renal artery aneurysm
* Branch renal artery disease and hypertension
* Preservation of renal function if severe stenosis

=== Chronic ===

==== Screening ====

* All patients with FMD anywhere are recommended to be screened for intracranial aneurysms with CTA or MRA

==== Hypertension ====

* First-line is ACEi/ARB
* Can consider percutaneous transluminal angioplasty

==== Dissection ====

* LMWH or wardarin for 3 to 6 months, or antiplatelet therapy

==== Follow-up ====

* Monitor blood pressure and creatinine every three months, then annually if stable
* Duplex ultrasound or other noninvasive imaging of the involved arteries every 6 to 12 months

== Further Reading ==

* Olin ''et al.'' [https://doi.org/10.1161/01.cir.0000442577.96802.8c Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions]. ''Circulation'' 2014;129:1048-1078.

[[Category:Rheumatology]]