Jeffrey W. Olin, DO, Brett A. Sealove, MD Journal of Vascular Surgery

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Presentation transcript:

Diagnosis, management, and future developments of fibromuscular dysplasia Jeffrey W. Olin, DO, Brett A. Sealove, MD Journal of Vascular Surgery Volume 53, Issue 3, Pages 826-836.e1 (March 2011) DOI: 10.1016/j.jvs.2010.10.066 Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 1 A 54-year-old woman underwent angiography of the carotid arteries before surgery for a carotid body tumor. A, Left carotid artery injection demonstrates a carotid body tumor (arrow), and medial fibroplasia (small arrows) that were incidentally discovered. B, Outpouching (arrow) commonly seen in patients with medial fibroplasia may represent a small pseudoaneurysm. (Han DK, Fishman EW, Walkup MH, Olin JW, Marin ML, Faries PL. A rare case of familial carotid body tumor in a patient with bilateral fibromuscular dysplasia. J Vasc Surg 2010;52:746-50.) Journal of Vascular Surgery 2011 53, 826-836.e1DOI: (10.1016/j.jvs.2010.10.066) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 2 A, A catheter-based angiogram in a 35-year-old woman with new-onset of severe high blood pressure demonstrated fibromuscular dysplasia of the right renal artery (black arrows) and two small aneurysms (6 mm) more distally (white arrows). B, Aortogram in a patient with medial fibroplasia of the middle and distal renal arteries and the branches shows a large marginal artery (arrow) indicating severe disease or occlusion of the superior mesenteric artery. There is also fibromuscular dysplasia of the celiac and superior mesenteric artery (not shown). Journal of Vascular Surgery 2011 53, 826-836.e1DOI: (10.1016/j.jvs.2010.10.066) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 3 A 48-year-old man presented with bilateral flank pain and increased serum creatinine. A, There is a concentric severe stenosis (arrow) of the right renal artery characteristic of intimal disease. B, There is a dissection (arrow) in the left renal artery with dilatation of the distal main renal artery and infarction of the upper pole of the left kidney (not shown). (Reproduced with permission from Olin JW, Pierce M. Contemporary management of fibromuscular dysplasia. Curr Opin Cardiol 2008;23(6):527-36.) Journal of Vascular Surgery 2011 53, 826-836.e1DOI: (10.1016/j.jvs.2010.10.066) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 4 A, Typical medial fibroplasia of the right internal carotid artery. Note the “beading” is located in the middle and distal portion of the internal carotid artery, whereas atherosclerosis occurs at the origin of the internal carotid artery. B, This 51-year-old patient demonstrates severe tortuosity of the left internal carotid artery. She has medial fibroplasia of the renal arteries and an occluded right internal carotid artery from dissection. Journal of Vascular Surgery 2011 53, 826-836.e1DOI: (10.1016/j.jvs.2010.10.066) Copyright © 2011 Society for Vascular Surgery Terms and Conditions

Fig 5 Medial fibroplasia of the external iliac arteries in a patient who presented with claudication. (Photograph courtesy of J. Michael Bacharach, MD.) Journal of Vascular Surgery 2011 53, 826-836.e1DOI: (10.1016/j.jvs.2010.10.066) Copyright © 2011 Society for Vascular Surgery Terms and Conditions