Fibromuscular Dysplasia, or FMD, is a medical condition characterized by abnormal cell growth within the walls of arteries. This growth is not related to inflammation or the plaque buildup seen in atherosclerosis. The unusual development of cells can cause arteries to narrow, or result in bulges known as aneurysms and tears called dissections. While a definitive cure for FMD has not been established, a range of effective treatments exists to manage symptoms and address potential complications.
Primary Goals of FMD Treatment
A central objective in managing FMD is the control of high blood pressure. Many individuals with FMD develop renovascular hypertension, a form of high blood pressure specifically caused by the narrowing of arteries leading to the kidneys. Managing blood pressure is a primary focus because it reduces strain on the entire vascular system.
Another main goal of treatment is to prevent serious vascular events. The irregular structure of arteries affected by FMD increases the risk of complications such as arterial dissections, which are tears in the artery’s inner wall, and aneurysms. These events can disrupt blood flow and lead to significant health issues, including stroke.
Treatment also focuses on alleviating the direct symptoms that arise from reduced blood flow to affected areas. Patients may experience symptoms like persistent headaches, a rhythmic whooshing sound in the ears known as pulsatile tinnitus, dizziness, or neck pain.
Medication-Based Management
A common approach to managing FMD involves the use of antiplatelet therapy, with low-dose aspirin being a frequent choice. This medication prevents blood clots from forming on the irregular arterial surfaces caused by FMD. Preventing these clots helps lower the risk of ischemic events, such as a stroke, where blood flow to a part of the brain is blocked.
Controlling blood pressure is another pillar of pharmacological management, achieved through antihypertensive medications. Doctors may prescribe drugs from several different classes depending on the patient’s specific needs. These can include Angiotensin-Converting Enzyme (ACE) inhibitors and Angiotensin II Receptor Blockers (ARBs), which help relax blood vessels. Calcium Channel Blockers are another option that can be effective in lowering blood pressure.
The selection of a specific blood pressure medication is tailored to the individual. Factors influencing this choice include which arteries are affected by FMD and the patient’s overall health profile. For instance, the management strategy for someone with FMD in the renal arteries may differ from that for a person with involvement of the carotid arteries.
Procedural Interventions for Blockages
When medications are insufficient to control symptoms or when a severe narrowing, called stenosis, is present, a procedure may be recommended. The most common intervention for FMD is Percutaneous Transluminal Angioplasty (PTA). During this minimally invasive procedure, a catheter with a small balloon at its tip is guided to the narrowed artery. The balloon is then inflated to gently stretch the artery open, improving blood flow without leaving a permanent implant behind.
Stents, small expandable mesh tubes, are not the first choice for treating FMD. Stenting is reserved for specific, complex situations. For example, a stent might be placed if an arterial dissection occurs as a complication of the angioplasty procedure itself. The stent acts as a scaffold to hold the torn artery open and facilitate healing.
In rare instances, surgical revascularization may be considered. This approach involves open surgery, such as creating a bypass around the affected arterial segment using a vessel from another part of the body. Surgery is reserved for cases where PTA is not technically possible or has been attempted without success.
Long-Term Monitoring and Lifestyle
Managing FMD is a lifelong process that requires consistent follow-up and monitoring. Patients can expect to have regular appointments with a specialist who has expertise in vascular diseases. These visits are important for tracking the condition and making any necessary adjustments to the treatment plan.
Periodic surveillance imaging is part of long-term care. To monitor the arteries, doctors use non-invasive tests such as Duplex ultrasound, CT angiography (CTA), or MR angiography (MRA). These imaging studies help detect any new areas of FMD or check for the progression of the disease in previously identified locations. The frequency of these scans is determined by the physician based on the individual’s specific circumstances.
Lifestyle choices play a significant part in the overall management of cardiovascular health. For individuals with FMD, smoking cessation is strongly recommended, as tobacco use is a known risk factor for the progression of vascular conditions. Adopting a heart-healthy diet rich in fruits and vegetables and engaging in moderate, regular exercise are also beneficial. These habits help control blood pressure and support circulatory health.