eMedicine Specialties > Radiology > Vascular/Interventional
Fibromuscular Dysplasia (Visceral Arteries): Follow-up
Updated: May 28, 2008
Intervention
Tremendous controversy surrounds the optimal treatment of patients with renal vascular disease. This debate is compounded by the fact that patients are not a homogeneous group; each has a different prognosis and potential response to therapy.
Therapeutic options include medical management, surgery, and percutaneous approaches (angioplasty or stenting). For patients with fibromuscular disease, the results of percutaneous management are generally superior to those of medical therapy. Although data from observational studies are difficult to compare, results with interventional procedures appear to be roughly similar to those of medical therapy in patients with atheromatous disease.23,27,59,60,61,62,63,64,65,66,67,68,69,70,71
Three randomized, prospective trials have been conducted to compare routine angioplasty with medical management. These trials showed little advantage with interventional therapies in patients whose blood pressure was well controlled with medication and who did not have progression of renal insufficiency during medical care. Given these data, the potential management strategy should be based on an individualized risk-benefit assessment.
Clinically significant cortical and/or medullary atrophy has been demonstrated in poststenotic kidneys compared with contralateral normal kidneys. Despite intraparenchymal disease, clinical outcomes are favorable after revascularization. Cortical and/or medullary thinning appears to be an early marker of renal ischemia that could support revascularization in FMD disease with renal artery angioplasty. Isolated dissection of the renal artery is a rare condition that has been reported in association with FMD.
Medical therapy
Medical treatment of FMD-associated hypertension carries the risk of further reduction of renal blood flow, which may result in ischemic atrophy or even total infarction of the involved kidney. If treatment with antihypertensive drugs is instituted, optimal blood-pressure control is essential. ACE inhibitors should be avoided. Other risk factors, such as cessation of smoking and hyperlipidemia, should be addressed. Definitive therapy should always be considered to prevent ischemic nephropathy.62,65,70
Surgical options
Surgical bypass, such as by an autogenous vein grafting to replace the artery, with excision and repair by means of patch angioplasty or end-to-end anastomoses of the stenotic segment, was once the preferred option. With surgery, the vascular anatomy is restored permanently. However, surgery requires general anesthesia. Moreover, the cost of surgery is high owing to long hospital stay with possible procedure-related complications; the mortality rate is 2.2-7.8%.59,60,61,63,64,66,67,68,69
Reiher et al examined the long-term results of surgical reconstruction of FMD of the renal artery.64 They retrospectively reviewed preprocedural and postprocedural clinical records of 101 patients (80 women, 21 men; mean age at surgery, 43 y). All surviving patients were invited for clinical reexamination and color duplex US of the renal arteries.
Initial technical success was achieved in 83 (89%) of 93 patients, in whom postoperative angiography (90 patients) or renal scintigraphy (2 patients) was performed to assess renal artery reconstruction (RAR). Early occlusion (4 patients) or stenosis (1 patient) resulted in repeat surgery in 5 patients (5%). The 30-day mortality and morbidity rates were 2% and 12% for the entire group. The primary patency rate was 74% at 5 years. Fifteen patients had to undergo repeat surgery for restenosis after a mean time of 33 months, resulting in a secondary patency rate of 85% after 5 years. In 61 patients with a patent RAR at the time of reexamination, arterial hypertension was cured only in 22 (36%); improvement was observed in 19 (31%).
The authors concluded that vascular surgery for renal FMD yields good long-term results with regard to kidney perfusion and function. They suggested that surveillance of RAR-patency by means of US is mandatory in cases of recurrence or deterioration of arterial hypertension. Rates of cure of hypertension were disappointing.
Percutaneous transluminal angioplasty
PTA has become the procedure of choice for the treatment of symptomatic stenoses of visceral arteries, particularly those caused by FMD. Patency rates after PTA strongly depend on the size of the vessel treated and the quality of inflow and outflow through the vessel. RAS is an established cause of renovascular hypertension and chronic renal insufficiency. Because of the excellent results obtained with renal angioplasty, it is the most commonly performed procedure in symptomatic RAS. PTA may completely relieve the stenosis and cure hypertension in FMD; however, most patients still require some antihypertensive medication, and as many as 25% of patients have restenosis after 1 year.65
Angioplasty was previously considered a contraindication in patients with a solitary or transplanted kidney. This is no longer the case, and in fact, angioplasty is now considered the procedure of choice for treatment of RAS in these patients. Technical success is achieved in more than 90% of patients. Patency rates of 90-95% at 2 years for FMD and 80-85% for atherosclerosis are commonly reported. Angioplasty of other visceral arteries has been reported infrequently, but it appears to be similar to renal artery angioplasty in terms of success and patency rates.
Mounier-Vehier et al demonstrated significant cortical and/or medullary atrophy in poststenotic kidneys compared to contralateral normal kidneys.27 They assessed 20 patients (18 women, 2 men; age 48.7 ± 15.4 y) with hypertension and unilateral de novo FMD stenosis before and 6 months after revascularization (balloon angioplasty in 19 patients, bypass surgery in 1). Despite intraparenchymal disease, clinical outcomes were favorable after revascularization. Cortical and/or medullary thinning appeared to be an early marker of renal ischemia that could support revascularization in FMD disease.
Birrer assessed restenosis rates and blood pressure response in 27 patients 12 months after PTRA in patients treated for FMD RAS.66 Although the restenosis rate after PTRA in FMD was as high as that in nonostial atherosclerotic lesions, a considerably increased therapeutic effect remained. Profound pressure response and recurrent arterial hypertension with restenosis supported the high probability of a renovascular origin of arterial hypertension in this young and otherwise healthy population compared with patients with atherosclerotic lesions of the renal artery.
Vascular stent placement
Vascular stenting is considered complementary to PTA. The general consensus at the moment is that stenting should be reserved for patients in whom angioplasty fails. Many vascular stents are now available. Stents used in the recanalization of renal arteries are metallic devices, which are either self-expanding or balloon expandable. The United States Food and Drug Administration (FDA) has approved a few stents for peripheral use, coronary work, and transjugular intrahepatic portosystemic shunt (TIPS) procedures.
PTA is the treatment of choice for FMD, with excellent outcomes. Stenting is performed for orificial RAS, usually atherosclerotic, and for cases in which PTA fails or causes complications, such as flow-limiting dissection. Most renal-artery stenting is performed with balloon-expandable stents; some procedures are performed with self-expanding or covered stents. Strecker tantalum stents are not used in the United States.67 Because renal failure is a major complication of PTA and stenting (as a result of cholesterol embolism), renal angioplasty with distal protection will be used increasingly in the future.
The ultimate role of stents in the treatment of vascular disease has yet to be established, but these devices have already had a dramatic effect on the practice of interventional radiology. In studies from both the United States and Europe, stenting of small vessels has resulted in an unacceptably high incidence of thrombosis.
Strecker et al described the extended role of knitted flexible tantalum stents as a valuable adjunct to PTA in cases in which PTA results were insufficient.67 The use of this technique is now established in the distal aorta, the iliac. Long arterial occlusions were recently defined as new indications for primary stenting; indications were further extended to the subclavian, the carotid, and the splanchnic arteries, including the renal arteries. The authors suggested that because of the high incidence of acute and late complications after stent treatment of small-diameter arteries, patients must be thoroughly screened and carefully selected.
Newly designed drug-releasing stents tested in animal experiments may diminish the incidence of late restenosis caused by intimal hyperplasia, thereby improving long-term patency.
Intravascular US-guided atherectomy
A single case report describes the successful diagnosis of hypertension secondary to FMD with intravascular US and curative intravascular US-guided renal atherectomy.
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References
Stanley JC, Gewertz BL, Bove EL, et al. Arterial fibrodysplasia. Histopathologic character and current etiologic concepts. Arch Surg. May 1975;110(5):561-6. [Medline].
Iwai T, Konno S, Hiejima K, et al. Fibromuscular dysplasia in the extremities. J Cardiovasc Surg (Torino). Sep-Oct 1985;26(5):496-501. [Medline].
Begelman SM, Olin JW. Fibromuscular dysplasia. Curr Opin Rheumatol. Jan 2000;12(1):41-7. [Medline].
Curry TK, Messina LM. Fibromuscular dysplasia: when is intervention warranted?. Semin Vasc Surg. Sep 2003;16(3):190-9. [Medline].
Insall RL, Chamberlain J, Loose HW. Fibromuscular dysplasia of visceral arteries. Eur J Vasc Surg. Nov 1992;6(6):668-72. [Medline].
Rafalowska J. Genetically determined vascular diseases. Folia Neuropathol. 1999;37(4):210-6. [Medline].
Yamaguchi R, Yamaguchi A, Isogai M, et al. Fibromuscular dysplasia of the visceral arteries. Am J Gastroenterol. Aug 1996;91(8):1635-8. [Medline].
Andreoni KA, Weeks SM, Gerber DA, et al. Incidence of donor renal fibromuscular dysplasia: does it justify routine angiography?. Transplantation. Apr 15 2002;73(7):1112-6. [Medline].
Leadbetter WF, Burkland CE. Hypertension in unilateral renal disease. J Urology. 1938;39:611-25.
Dunick NR. Renovascular Hypertension: Text of Uroradiology. 3rd ed. Philadelphia, PA: Lippincott William & Wilkins;. 2001: 215.
Lassiter FD. The string-of-beads sign. Radiology. Feb 1998;206(2):437-8. [Medline].
McCormack LJ, Dusten JP, Meaney TF. Selected pathology of the renal artery. Semin Roentenol. 1967;2:126-38.
Wagner WH, Allins AD, Treiman RL, et al. Ruptured visceral artery aneurysms. Ann Vasc Surg. Jul 1997;11(4):342-7. [Medline].
Sang CN, Whelton PK, Hamper UM, et al. Etiologic factors in renovascular fibromuscular dysplasia. A case-control study. Hypertension. Nov 1989;14(5):472-9. [Medline].
Schievink WI, Bjornsson J, Parisi JE, Prakash UB. Arterial fibromuscular dysplasia associated with severe alpha 1-antitrypsin deficiency. Mayo Clin Proc. Nov 1994;69(11):1040-3. [Medline].
Grange DK, Balfour IC, Chen SC, Wood EG. Familial syndrome of progressive arterial occlusive disease consistent with fibromuscular dysplasia, hypertension, congenital cardiac defects, bone fragility, brachysyndactyly, and learning disabilities. Am J Med Genet. Feb 17 1998;75(5):469-80. [Medline].
Schievink WI, Meyer FB, Parisi JE, Wijdicks EF. Fibromuscular dysplasia of the internal carotid artery associated with alpha1-antitrypsin deficiency. Neurosurgery. Aug 1998;43(2):229-33; discussion 233-4. [Medline].
Boutouyrie P, Gimenez-Roqueplo AP, Fine E, et al. Evidence for carotid and radial artery wall subclinical lesions in renal fibromuscular dysplasia. J Hypertens. Dec 2003;21(12):2287-95. [Medline].
Meacham PW, Brantley B. Familial fibromuscular dysplasia of the mesenteric arteries. South Med J. Oct 1987;80(10):1311-6. [Medline].
Textor SC. Pathophysiology of renovascular hypertension. Urol Clin North Am. Aug 1984;11(3):373-81. [Medline].
Weaver FA, Kuehne JP, Papanicolaou G. A recent institutional experience with renovascular hypertension. Am Surg. Mar 1996;62(3):241-5. [Medline].
Estepa R, Gallego N, Orte L, et al. Renovascular hypertension in children. Scand J Urol Nephrol. Oct 2001;35(5):388-92. [Medline].
Tyagi S, Kaul UA, Satsangi DK, Arora R. Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results. Pediatrics. Jan 1997;99(1):44-9. [Medline].
SCHREIBER MH, SARLES HE, HERRING ME, REMMERS AR Jr. THE PYELOGRAM-UREA WASHOUT TEST. ITS VALUE IN THE DIAGNOSIS OF RENOVASCULAR HYPERTENSION. N Engl J Med. Jun 4 1964;270:1223-7. [Medline].
Goncharenko V, Gerlock AJ, Shaff MI, Hollifield JW. Progression of renal artery fibromuscular dysplasia in 42 patients as seen on angiography. Radiology. Apr 1981;139(1):45-51. [Medline].
Pohl MA, Novick AC. Natural history of atherosclerotic and fibrous renal artery disease: clinical implications. Am J Kidney Dis. Apr 1985;5(4):A120-30. [Medline].
Mounier-Vehier C, Haulon S, Devos P, et al. Renal atrophy outcome after revascularization in fibromuscular dysplasia disease. J Endovasc Ther. Oct 2002;9(5):605-13. [Medline].
Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med. Feb 8 2001;344(6):431-42. [Medline].
Stanley JC. Renal artery fibrodysplasia. In: Novick AC, Soble J, Hamilton G, eds. Renal vascular disease. Philadelpha, Pa: WB Saunders;. 1996: 21-3.
Abbas MA, Fowl RJ, Stone WM, et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg. Jul 2003;38(1):41-5. [Medline].
Cragg AH, Smith TP, Thompson BH, et al. Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology. Jul 1989;172(1):145-7. [Medline].
Matsushita M, Yano T, Ikezawa T, et al. Fibromuscular dysplasia as a cause of abdominal aortic aneurysm. Cardiovasc Surg. Oct 1994;2(5):615-8. [Medline].
Safioleas M, Kakisis J, Manti C. Coexistence of hypertrophic cardiomyopathy and fibromuscular dysplasia of the superior mesenteric artery. N Engl J Med. Apr 26 2001;344(17):1333-4. [Medline].
Dondi M, Fanti S, De Fabritiis A, et al. Prognostic value of captopril renal scintigraphy in renovascular hypertension. J Nucl Med. Nov 1992;33(11):2040-4. [Medline].
Roccatello D, Picciotto G, Rabbia C, et al. Prospective study on captopril renography in hypertensive patients. Am J Nephrol. 1992;12(6):406-11. [Medline].
Tanoi Y, Okeda R, Budka H. Binswanger''s encephalopathy: serial sections and morphometry of the cerebral arteries. Acta Neuropathol (Berl). Oct 2000;100(4):347-55. [Medline].
Tohgi H, Chiba K, Kimura M. Twenty-four-hour variation of blood pressure in vascular dementia of the Binswanger type. Stroke. May 1991;22(5):603-8. [Medline].
Weymann S, Yonekawa Y, Khan N, et al. Severe arterial occlusive disorder and brachysyndactyly in a boy: a further case of Grange syndrome?. Am J Med Genet. Mar 15 2001;99(3):190-5. [Medline].
Olbricht CJ, Paul K, Prokop M, et al. Minimally invasive diagnosis of renal artery stenosis by spiral computed tomography angiography. Kidney Int. Oct 1995;48(4):1332-7. [Medline].
Leung DA, Hoffmann U, Pfammatter T, et al. Magnetic resonance angiography versus duplex sonography for diagnosing renovascular disease. Hypertension. Feb 1999;33(2):726-31. [Medline].
Prince MR, Schoenberg SO, Ward JS, et al. Hemodynamically significant atherosclerotic renal artery stenosis: MR angiographic features. Radiology. Oct 1997;205(1):128-36. [Medline].
Marcos HB, Choyke PL. Magnetic resonance angiography of the kidney. Semin Nephrol. Sep 2000;20(5):450-5. [Medline].
Papachristopoulos G, Bis KG, Shetty AN, et al. Breath-hold 3D MR angiography of the renal vasculature using a contrast-enhanced multiecho gradient-echo technique. Invest Radiol. Dec 1999;34(12):731-8. [Medline].
Beregi JP, Louvegny S, Gautier C, et al. Fibromuscular dysplasia of the renal arteries: comparison of helical CT angiography and arteriography. AJR Am J Roentgenol. Jan 1999;172(1):27-34. [Medline].
Avasthi PS, Greene ER, Scholler C, Fowler CR. Noninvasive diagnosis of renal vein thrombosis by ultrasonic echo-Doppler flowmetry. Kidney Int. Jun 1983;23(6):882-7. [Medline].
Taylor DC, Kettler MD, Moneta GL, et al. Duplex ultrasound scanning in the diagnosis of renal artery stenosis: a prospective evaluation. J Vasc Surg. Feb 1988;7(2):363-9. [Medline].
Berland LL, Koslin DB, Routh WD, Keller FS. Renal artery stenosis: prospective evaluation of diagnosis with color duplex US compared with angiography. Work in progress. Radiology. Feb 1990;174(2):421-3. [Medline].
Nazzal MM, Hoballah JJ, Miller EV, et al. Renal hilar Doppler analysis is of value in the management of patients with renovascular disease. Am J Surg. Aug 1997;174(2):164-8. [Medline].
Vasbinder GB, Nelemans PJ, Kessels AG, et al. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med. Sep 18 2001;135(6):401-11. [Medline].
Kaatee R, Beek FJ, Verschuyl EJ, et al. Atherosclerotic renal artery stenosis: ostial or truncal?. Radiology. Jun 1996;199(3):637-40. [Medline].
Verswijvel G, Van Hoe L, Stockx L, Oyen R. Magnetic susceptibility artifacts by titanium surgical clips mimicking fibromuscular dysplasia of the renal artery in a kidney transplant. Eur Radiol. 2000;10(3):543. [Medline].
Gowda MS, Loeb AL, Crouse LJ, Kramer PH. Complementary roles of color-flow duplex imaging and intravascular ultrasound in the diagnosis of renal artery fibromuscular dysplasia: should renal arteriography serve as the "gold standard"?. J Am Coll Cardiol. Apr 16 2003;41(8):1305-11. [Medline].
Stavros AT, Parker SH, Yakes WF, et al. Segmental stenosis of the renal artery: pattern recognition of tardus and parvus abnormalities with duplex sonography. Radiology. Aug 1992;184(2):487-92. [Medline].
Kohler TR, Zierler RE, Martin RL, et al. Noninvasive diagnosis of renal artery stenosis by ultrasonic duplex scanning. J Vasc Surg. Nov 1986;4(5):450-6. [Medline].
Ergun EL, Caglar M, Erdem Y, et al. Tc-99m DTPA acetylsalicylic acid (aspirin) renography in the detection of renovascular hypertension. Clin Nucl Med. Sep 2000;25(9):682-90. [Medline].
Imanishi M, Yano M, Okumura M, et al. Aspirin renography in diagnosis of unilateral renovascular hypertension. Hypertens Res. Sep 1998;21(3):209-13. [Medline].
Maini A, Gambhir S, Singhal M, Kher V. Aspirin renography in the diagnosis of renovascular hypertension: a comparative study with captopril renography. Nucl Med Commun. Apr 2000;21(4):325-31. [Medline].
van de Ven PJ, de Klerk JM, Mertens IJ, et al. Aspirin renography and captopril renography in the diagnosis of renal artery stenosis. J Nucl Med. Aug 2000;41(8):1337-42. [Medline].
Kojima A, Shindo S, Kubota K, et al. Successful surgical treatment of a patient with multiple visceral artery aneurysms due to fibromuscular dysplasia. Cardiovasc Surg. Apr 2002;10(2):157-60. [Medline].
Tegtmeyer CJ, Elson J, Glass TA, et al. Percutaneous transluminal angioplasty: the treatment of choice for renovascular hypertension due to fibromuscular dysplasia. Radiology. Jun 1982;143(3):631-7. [Medline].
Dean RH, Benjamin ME, Hansen KJ. Surgical management of renovascular hypertension. Curr Probl Surg. Mar 1997;34(3):209-308. [Medline].
Bloch MJ, Pickering T. Renal vascular disease: medical management, angioplasty, and stenting. Semin Nephrol. Sep 2000;20(5):474-88. [Medline].
Steinbach F, Novick AC, Campbell S, Dykstra D. Long-term survival after surgical revascularization for atherosclerotic renal artery disease. J Urol. Jul 1997;158(1):38-41. [Medline].
Reiher L, Pfeiffer T, Sandmann W. Long-term results after surgical reconstruction for renal artery fibromuscular dysplasia. Eur J Vasc Endovasc Surg. Dec 2000;20(6):556-9. [Medline].
Aurell M, Jensen G. Treatment of renovascular hypertension. Nephron. 1997;75(4):373-83. [Medline].
Birrer M, Do DD, Mahler F, et al. Treatment of renal artery fibromuscular dysplasia with balloon angioplasty: a prospective follow-up study. Eur J Vasc Endovasc Surg. Feb 2002;23(2):146-52. [Medline].
Strecker EP, Hagen B, Liermann D, et al. Current status of the Strecker stent. Cardiol Clin. Nov 1994;12(4):673-87. [Medline].
Hoshino Y, Nakamura T, Nakano A, et al. Successful treatment of renovascular hypertension due to fibromuscular dysplasia by intravascular ultrasound-guided atherectomy. Nephron. Jul 2002;91(3):521-5. [Medline].
O''Neill JA. Long-term outcome with surgical treatment of renovascular hypertension. J Pediatr Surg. Jan 1998;33(1):106-11. [Medline].
Ramamoorthy SL, Vasquez JC, Taft PM, et al. Nonoperative management of acute spontaneous renal artery dissection. Ann Vasc Surg. Mar 2002;16(2):157-62. [Medline].
Surowiec SM, Sivamurthy N, Rhodes JM, et al. Percutaneous therapy for renal artery fibromuscular dysplasia. Ann Vasc Surg. Nov 2003;17(6):650-5. [Medline].
Belen D, Bolay H, Firat M, et al. Unusual appearance of intracranial fibromuscular dysplasia. A case report. Angiology. Jun 1996;47(6):627-32. [Medline].
Broekhuizen-de Gast HS, Tiel-van Buul MM, Van Beek EJ. Severe hypertension in children with renovascular disease. Clin Nucl Med. Jul 2001;26(7):606-9. [Medline].
Camacho A, Villarejo A, Moreno T, et al. Vertebral artery fibromuscular dysplasia: an unusual cause of stroke in a 3-year-old child. Dev Med Child Neurol. Oct 2003;45(10):709-11. [Medline].
Chan RJ, Goodman TA, Aretz TH, Lie JT. Segmental mediolytic arteriopathy of the splenic and hepatic arteries mimicking systemic necrotizing vasculitis. Arthritis Rheum. May 1998;41(5):935-8. [Medline].
Cloft HJ, Kallmes DF, Kallmes MH, et al. Prevalence of cerebral aneurysms in patients with fibromuscular dysplasia: a reassessment. J Neurosurg. Mar 1998;88(3):436-40. [Medline].
Courtel JV, Soto B, Niaudet P, et al. Percutaneous transluminal angioplasty of renal artery stenosis in children. Pediatr Radiol. Jan 1998;28(1):59-63. [Medline].
Dejardin A, Goffette P, Moulin P, et al. Severe hypoplasia of the abdominal aorta and its branches in a patient and his daughter. J Intern Med. Jan 2004;255(1):130-6. [Medline].
Hamed RM, Ghandour K. Abdominal angina and intestinal gangrene--a catastrophic presentation of arterial fibromuscular dysplasia: case report and review of the literature. J Pediatr Surg. Sep 1997;32(9):1379-80. [Medline].
Horie T, Seino Y, Miyauchi Y, et al. Unusual petal-like fibromuscular dysplasia as a cause of acute abdomen and circulatory shock. Jpn Heart J. May 2002;43(3):301-5. [Medline].
Inada K, Maeda M, Ikeda T. Segmental arterial mediolysis: unrecognized cases culled from cases of ruptured aneurysm of abdominal visceral arteries reported in the Japanese literature. Pathol Res Pract. 2007;203(11):771-8. [Medline].
Jones HJ, Staud R, Williams RC Jr. Rupture of a hepatic artery aneurysm and renal infarction: 2 complications of fibromuscular dysplasia that mimic vasculitis. J Rheumatol. Oct 1998;25(10):2015-8. [Medline].
Kim D, Porter DH, Brown R, et al. Renal artery imaging: a prospective comparison of intra-arterial digital subtraction angiography with conventional angiography. Angiology. May 1991;42(5):345-57. [Medline].
Kuwabara N, Kuwahara T, Takahashi K, et al. Common iliac artery aneurysm due to fibromuscular dysplasia in infants. Eur J Pediatr Surg. Feb 2001;11(1):69-71. [Medline].
Lin YJ, Hwang B, Lee PC, Yang LY, Meng CC. Mid-aortic syndrome: a case report and review of the literature. Int J Cardiol. Jan 24 2008;123(3):348-52. [Medline].
Malagò R, D'Onofrio M, Mucelli RP. Fibromuscular dysplasia: noninvasive evaluation of unusual case of renal and mesenteric involvement. Urology. Apr 2008;71(4):755.e13-5. [Medline].
Massachusetts General Hospital. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 9-1995. A 60-year-old man with hypertrophic cardiomyopathy and ischemic colitis. N Engl J Med. Mar 23 1995;332(12):804-10. [Medline].
McWilliams RG, Godfrey H, Bakran A, et al. Delayed pseudoaneurysm after renal artery angioplasty. J Endovasc Ther. Feb 2002;9(1):48-53. [Medline].
Motew SJ, Cherr GS, Craven TE, et al. Renal duplex sonography: main renal artery versus hilar analysis. J Vasc Surg. Sep 2000;32(3):462-9; 469-71. [Medline].
Pokrovskii AV, Spiridonov AA, Arabidze GG, Petrosian IuS, Kozdoba OA. [Surgical treatment of renovascular hypertension (20-year experience at the All-Union Cardiologic Research Center of the USSR Academy of Medical Sciences and at the A. N. Bakulev Institute of Cardiovascular Surgery of the USSR Academy of Medical Sciences]. Vestn Akad Med Nauk SSSR. 1982;61-5. [Medline].
Salifu MO, Gordon DH, Friedman EA, Delano BG. Bilateral renal infarction in a black man with medial fibromuscular dysplasia. Am J Kidney Dis. Jul 2000;36(1):184-9. [Medline].
Sandmann W, Schulte KM. Multivisceral fibromuscular dysplasia in childhood: case report and review of the literature. Ann Vasc Surg. Sep 2000;14(5):496-502. [Medline].
Siegert CE, Macfarlane JD, Hollander AM, van Kemenade F. Systemic fibromuscular dysplasia masquerading as polyarteritis nodosa. Nephrol Dial Transplant. Jul 1996;11(7):1356-8. [Medline].
Spiridonov AA, Tutov EG, Isaeva IV. [Methods of plastic surgery of the renal arteries in children with vasorenal hypertension]. Grud Serdechnososudistaia Khir. 1992;19-23. [Medline].
Stanley JC, Zelenock GB, Messina LM, Wakefield TW. Pediatric renovascular hypertension: a thirty-year experience of operative treatment. J Vasc Surg. Feb 1995;21(2):212-26; discussion 226-7. [Medline].
Steinmetz EF, Berry P, Shames ML, et al. "Grape cluster" aneurysm of the right subclavian artery: an unusual manifestation of fibromuscular dysplasia. Ann Vasc Surg. May 2003;17(3):296-301. [Medline].
Tsukamoto Y, Komuro Y, Akutsu F, et al. Orthostatic hypertension due to coexistence of renal fibromuscular dysplasia and nephroptosis. Jpn Circ J. Dec 1988;52(12):1408-14. [Medline].
Further Reading
Keywords
FMD, carotid artery stenosis, carotid artery aneurysm, visceral artery stenosis, visceral artery aneurysm, peripheral artery stenosis, peripheral artery aneurysm, renal artery stenosis, renal-artery stenosis, RAS, renal artery fibrosing lesions, intimal fibroplasia, medial fibrosis with microaneurysms, subadventitial fibroplasia, fibromuscular hyperplasia, segmental mediolytic arteriopathy, alpha-1-antitrypsin deficiency, AAT deficiency
