Digital artery embolization as a result of fibromuscular dysplasia of the brachial artery

A 74-year-old woman was admitted to the hospital with sudden onset of a blue, painful right index finger, and the condition progressed to digital ulceration. The ulcer gradually healed over a period of 2 months. Peripheral pulses, Doppler-derived brachial and radial systolic pressures, and results of an echocardiogram were normal. Digital pulse volume recordings showed obstructive waveforms in all digits of the right hand. Arteriography showed a normal arch and normal innominate, subclavian, and axillary arteries. The midbrachial artery was markedly abnormal and had alternating areas of stenosis and aneurysm formation. Multiple occlusions involved the palmar arch and proper digital arteries. The abnormal brachial artery segment was excised and replaced with an autogenous reversed saphenous-vein conduit. Histologic examination confirmed the lesion to be medial fibromuscular dysplasia. Fibromuscular dysplasia that involves upper extremity arteries is extremely uncommon and rarely presents with digital artery embolization. This case emphasizes the importance of exclusion of proximal reconstructible arterial occlusive disease by means of complete arteriographic examination of patients who were admitted with unilateral finger or hand ischemia.     

Renal artery fibromuscular dysplasia

Fibromuscular dysplasia (FMD) encompasses a heterogeneous group of idiopathic, segmental, nonatherosclerotic diseases of the musculature of arterial walls, leading to the narrowing of small and medium-sized arteries. The most common locations of FMD are renal arteries and carotid arteries. The diagnosis of FMD is made on the "string of beads" appearance of the arteries. The French Health Authority recommends performing a CT scan or an MRA to assess the diagnosis of FMD. A recent meta-analysis showed the cure rates using current definitions of hypertension cure are only 36% and 54% after angioplasty and surgery, respectively.     

Carotid artery fibromuscular dysplasia

Extracranial carotid artery fibromuscular dysplasia (FMD) is a rare finding that is frequently incidental and asymptomatic. It usually occurs in middle-age women and is secondary to medial fibrodysplasia or, less commonly, intimal fibrodysplasia. The carotid artery may be elongated or kinked and associated aneurysms have been reported. Symptoms including transient ischemic attack or stroke are uncommon and are due to low flow or embolization of platelet aggregates. Digital subtraction angiography demonstrates high-grade stenosis with the characteristic "string of beads" pattern. Antiplatelet medication with sequential imaging is the accepted therapy for asymptomatic lesions. Graduated endoluminal dilation under direct vision should be reserved for patients with documented lateralizing symptoms.     

Ask-Upmark kidney with contralateral renal artery fibromuscular dysplasia

A case of Ask-Upmark kidney with coexistent contralateral renal artery fibromuscular dysplasia is presented with detailed light and electron microscopic findings. Both lesions are known to produce renin-mediated hypertension which was corrected in this patient by nephrectomy and contralateral renal artery bypass. Ask-Upmark kidney is briefly reviewed.     

Symptomatic fibromuscular dysplasia of the external iliac artery

The aim of this article is to report a case of symptomatic fibromuscular dysplasia (FMD) involving the external iliac arteries (EIAs). An 88-year-old woman was admitted to the vascular service, with a painful right posterior ankle ulcer that had progressively worsened during the course of a month. Her medical history included diabetes and hypertension. Bilateral lower-extremity pulses were absent, and femoral and tibial Doppler waveforms were monophasic. Pelvic and bilateral lower-extremity angiograms were obtained, which revealed findings in both EIAs consistent with a diagnosis of extrarenal FMD. Percutaneous transluminal angioplasty with subsequent stenting of the right EIA was performed, using a self-expanding stent. Completion digital subtraction angiography demonstrated a widely patent right EIA with brisk flow of contrast across the stent. Postprocedural arterial duplex scan showed a biphasic waveform pattern in the common femoral artery. FMD can involve the EIA and be associated with critical limb ischemia. FMD of the EIA responds well to endovascular management.     

Multiple basilar artery trunk aneurysms associated with fibromuscular dysplasia

Summary An association between fibromuscular dysplasia (FMD) and intracranial aneurysms has been proposed but the occurrence of multiple aneurysms on the trunk of basilar artery (BA) associated with FMD has not been previously reported.     

Traumatic occlusion in fibromuscular dysplasia of the carotid artery

A patient with fibromuscular dysplasia involving the cervical carotid artery developed subtotal occlusion after a trivial head injury. An association between occlusion in fibromuscular dysplasia-diseased carotid arteries and trivial blunt head injuries is suggested and appropriate treatment options are discussed.     

Renal fibromuscular dysplasia

Renal artery fibromuscular dysplasia is a noninflammatory, nonatherosclerotic vasculopathy that can affect renal arteries at various degrees with different severity. The etiology is still unknown, but there is a strong belief that a genetic disorder is the main cause for the pathogenesis of this disease. The main presentation is a sudden onset of recalcitrant hypertension at a young age, which is usually resistant to medical treatment. Once renal artery fibromuscular dysplasia is suspected, several diagnostic tools are available to make an accurate diagnosis. The advent of minimally invasive interventions has revolutionized the options for treatment. This update should provide the clinician with a base understanding of available evidence for diagnosing and treating renal artery fibromuscular dysplasia.     

Multiple aneurysms of the splenic artery caused by fibromuscular dysplasia

Splenic artery aneurysms (SAAs) are relatively rare. Moreover, there has been only one previous report of fibromuscular dysplasia (FMD) affecting the splenic artery alone. We describe a 64-year-old man with long, segmental, large, and multiple SAAs in whom the splenic artery branched from the aorta. The patient underwent endoaneurysmorrhaphy and splenectomy, with ligation in the proximal segment of the splenic artery. Histopathological analyses of resected specimens showed characteristics compatible with FMD. To our knowledge, long, segmental, large, and multiple SAAs caused by FMD have not previously been reported.     

Bilateral renal infarctions complicating fibromuscular dysplasia of renal arteries in a young male

Fibromuscular dysplasia (FMD) is an uncommon disorder, accounting for less than 10% of cases of renal artery stenosis, and typically presenting with hypertension in young women. This article reports the case of a previously healthy 37-year-old man presenting with acute-onset, severe, bilateral flank pain. Initially treated for ureteral colic and urinary tract infection, he was transferred to the nephrology clinic upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with a stenotic pattern on the right side and a dissecting aneurysm on the left side with resultant infarctions in both kidneys. On the basis of negative serological markers of vasculitis, a diagnosis of FMD complicated by bilateral renal infarctions was made. A stent was placed to the right stenotic renal artery, which resulted in sufficient lumen patency. No invasive procedure was performed on the other side owing to the complexity of the lesion. After 2.5 years of follow-up, the patient remained in good condition with normal renal function and adequate blood pressure control with dual antihypertensive therapy. Renal infarction complicating FMD of renal arteries is rare in the literature, with most of the cases having causative cardiovascular risk factors including coagulopathy, ischaemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. In conclusion, FMD may occur in atypical asymmetric presentations causing renal infarctions in both kidneys. Radiological interventions in such cases should focus on stabilizing renal lesions and renal function.     

Ischaemic proctitis and adventitial fibromuscular dysplasia of the superior rectal artery

A case of ischaemic proctitis apparently caused by adventitial fibromuscular dysplasia of the superior rectal artery is reported and the results of a survey of 50 superior rectal and marginal arteries from post mortem and surgical cases are described. Abnormal musculature was demonstrated in varying degree in the adventitia of 28 of 50 asymptomatic patients. Our findings indicate that a spectrum of this vascular abnormality exists in the elderly which is rarely severe enough to contribute to symptomatic large bowel ischaemia.     

Aneurysm of the extracranial internal carotid artery caused by fibromuscular dysplasia

A case of aneurysm of the extracranial internal carotid artery (ICA) caused by fibromuscular dysplasia (FMD) is reported. The patient also had an aneurysm of the contralateral intracranial ICA, but the renal arteries were normal. A review of the literature shows extracranial ICA aneurysms to be uncommon, with only 3% caused by FMD. The surgical management of such difficult lesions at the base of the skull is discussed.     

Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia

Balloon angioplasty is an established intervention to treat renovascular hypertension. Conventional balloon angioplasty is usually effective in cases of renovascular hypertension caused by fibromuscular dysplasia. In the present report, we describe two cases of renovascular hypertension caused by fibromuscular dysplasia in which stenotic lesions were resistant to conventional balloon angioplasty but were successfully managed by a cutting balloon. After cutting balloon angioplasty, systemic blood pressure was normalized in both patients, without the use of antihypertensive agents. Angioplasty by using a cutting balloon is a new therapeutic choice against renal artery stenosis that is resistant to dilation by a conventional balloon.     

Operative balloon angioplasty in the treatment of internal carotid artery fibromuscular dysplasia

Seven patients with symptomatic fibromuscular dysplasia have had eight internal carotid arteries treated by operative balloon dilatation. This technique is described in detail and provides three distinct advantages over conventional graduated intraluminal dilatation--atraumatic passage of the catheter through the affected vessel with fluoroscopic guidance; precise dilatation of the involved segment of the internal carotid artery; and the application of a radial force against the arterial wall rather than a longitudinal shear force, thereby making intimal damage less likely. There were no treatment complications in this group of patients. This technique of balloon angioplasty is compared with the results of treatment in eight patients with fibromuscular dysplasia of the internal carotid artery, who had percutaneous transfemoral angioplasty. Long-term follow-up revealed the resolution of symptoms in all patients.     

Two unusual variants of internal carotid artery aneurysms due to fibromuscular dysplasia

Aneurysms of the internal carotid artery (ICA) secondary to fibromuscular dysplasia (FMD) are extremely rare. We report two unique variants of extracranial ICA aneurysms due to FMD. The first patient was a hypertensive 51-year-old woman who was found to have a nontraumatic, nonmycotic saccular pseudoaneurysm of the right ICA. The second patient was a 46-year-old woman who presented with 90% stenosis and a focal dissecting aneurysm of the right ICA. Both underwent successful aneurysm resection with interposition saphenous vein grafting after anterior subluxation of the mandible. A review of the literature revealed only 21 other reported cases of aneurysms of the extracranial ICA due to FMD; all were managed successfully with surgical repair. Surgery can be performed with minimal or no morbidity, even in the distal ICA, if the exposure is adequate. Presented at the Fourth Annual Winter Meeting of the Peripheral Vascular Surgery Society, Breckenridge, Colo., January 21–23, 1994.     

Cervical and intracranial fibromuscular dysplasia

Fibromuscular dysplasia (FMD) is an uncommon, segmental, nonatherosclerotic arterial disease of unknown etiology, involving intermediate-sized arteries in many areas of the body. It affects primarily women. FMD is often asymptomatic and discovered as an incidental finding. It can, however, be associated with ischemic stroke spontaneous dissection, intracranial aneurysm, and hemodynamic compromise of the distal circulation, and therefore can be a cause of cerebral ischemic symptoms or subarachnoid hemorrhage in some patients.