Fibromuscular dysplasia (FMD) is a non-inflammatory and non-atherosclerotic vascular disease characterized by abnormal cell growth in the walls of arteries. This condition can affect various arteries throughout the body, with the renal arteries (supplying the kidneys) and carotid arteries (supplying the brain) being most commonly involved. The primary goals of FMD treatment involve managing associated symptoms, preventing potential complications such as stroke or aneurysm rupture, and improving blood flow through affected vessels.
Medication-Based Approaches
Blood pressure control is a primary focus, often addressed with angiotensin-converting enzyme (ACE) inhibitors like enalapril or lisinopril, or angiotensin receptor blockers (ARBs) such as losartan or valsartan. These medications help relax blood vessels, which can lower blood pressure. Other blood pressure medications, including beta-blockers like metoprolol and calcium channel blockers such as amlodipine, may also be prescribed.
For patients with FMD, particularly those with cerebrovascular involvement, antiplatelet therapy is recommended to prevent blood clots. Aspirin, typically in a low dose of 75-100 mg daily, is a frequently used antiplatelet agent to reduce the risk of stroke or transient ischemic attack.
Catheter-Based Procedures
Percutaneous transluminal angioplasty (PTA) is a common interventional treatment for FMD, particularly for narrowing in the renal arteries that causes high blood pressure. This procedure involves inserting a thin, flexible tube called a catheter into the affected artery, usually through a small incision in the groin. A tiny balloon at the end of the catheter is then inflated to widen the narrowed segment, improving blood flow.
PTA is recommended for symptomatic stenosis, such as uncontrolled high blood pressure or compromised organ function due to reduced blood flow. Recovery after PTA typically involves a short hospital stay and a period of limited activity. While effective, stenting—placing a metal mesh tube to keep the artery open—is generally avoided in FMD unless complications like arterial dissection occur or if angioplasty alone is unsuccessful.
Surgical Interventions
Surgical interventions for FMD are typically reserved for complex cases not suitable for or responsive to less invasive treatments like angioplasty. One such option is arterial bypass grafting, where a healthy blood vessel, often a saphenous vein from the patient’s leg, creates a new pathway for blood flow around a severely narrowed or blocked artery. This procedure is considered for extensive blockages or when angioplasty has failed.
Aneurysm repair is another surgical intervention for FMD-related arterial bulges. Depending on the aneurysm’s size, location, and complexity, repair might involve open surgical techniques like clipping, or less invasive endovascular coiling or stenting. These interventions prevent aneurysm rupture, which can lead to life-threatening bleeding.
Long-Term Management and Monitoring
FMD is a chronic condition requiring ongoing care and monitoring to manage symptoms and prevent complications. Regular follow-up appointments with a multidisciplinary team of specialists, including nephrologists, cardiologists, neurologists, and vascular specialists, ensure comprehensive oversight of the condition and its potential impact on various organ systems.
Monitoring involves regular blood pressure checks, which patients can perform at home, alongside periodic imaging studies. Imaging techniques like CT angiography, MR angiography, and duplex ultrasound assess affected arteries, monitor disease progression, and screen for new areas of involvement, including aneurysms or dissections. Lifestyle recommendations also support overall vascular health, such as smoking cessation, maintaining a balanced diet, and engaging in regular physical activity.