Treatment of fibromuscular dysplasia of the renal arteries
- Jeffrey W Olin, DO
Jeffrey W Olin, DO
- Professor of Medicine (Cardiology)
- Icahn School of Medicine at Mount Sinai
Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic disorder that leads to arterial stenosis, aneurysm, and dissection. It has been observed in nearly every arterial bed. The most often involved arteries are the renal and internal carotid arteries, and less often the vertebral, iliac, subclavian, and visceral arteries. When FMD occurs in the coronary arteries, the patient usually presents with a spontaneous coronary artery dissection.
Disease presentation may vary widely, depending upon the arterial segment involved and the severity of disease. The most common presenting manifestations are hypertension, headaches, pulsatile tinnitus, and dizziness. Less common are transient ischemic attack and stroke.
Treatment options for patients with renal artery FMD include medical therapy alone, or revascularization by either percutaneous transluminal angioplasty (PTA) or surgery . However, independent of angioplasty, hypertension should be treated.
The treatment of renal FMD will be reviewed here. The clinical manifestations and diagnosis of this disorder and the management of atherosclerotic renovascular disease and chronic kidney disease due to renal ischemia are discussed separately. (See "Clinical manifestations and diagnosis of fibromuscular dysplasia" and "Treatment of unilateral atherosclerotic renal artery stenosis" and "Treatment of bilateral atherosclerotic renal artery stenosis or stenosis to a solitary functioning kidney" and "Clinical manifestations and diagnosis of chronic kidney disease resulting from atherosclerotic renal artery stenosis".)
TREATMENT OF RENAL ARTERY FIBROMUSCULAR DYSPLASIA
The most common manifestation of renal artery fibromuscular dysplasia (FMD) is hypertension that is due to renal artery stenosis (see "Clinical manifestations and diagnosis of fibromuscular dysplasia", section on 'Clinical manifestations'). Options for management of hypertension in patients with FMD include antihypertensive drug therapy and revascularization.
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- TREATMENT OF RENAL ARTERY FIBROMUSCULAR DYSPLASIA
- Antihypertensive therapy
- - Choice of drug
- - Blood pressure goal
- Indications for revascularization
- - Rationale
- - Angioplasty versus surgery
- Percutaneous transluminal angioplasty
- Monitoring and follow-up
- TREATMENT OF NONRENAL LESIONS
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS