The role of several factors that have been suggested as being of etiologic importance in renovascular fibromuscular dysplasia was examined in a case-control study of 33 patients with angiographically demonstrated fibromuscular dysplasia and 61 renal transplant donor control subjects with normal renal arteries. The factors studied included use of oral contraceptive agents or markers of sex hormone dysfunction, mechanical stress to the renal artery wall, human lymphocytic antigen (HLA) type, cigarette smoking, history of hypertension for more than 5 years, and family history of cardiovascular disease. The risk of fibromuscular dysplasia was significantly (/»=0.003) increased (odds ratio=4.1, 95% confidence interval=1.5-10.9) among cigarette smokers. A significant (/xO.001) dose-response relation was noted between cigarette use and the risk of fibromuscular dysplasia developing (odds ratio=8.6 for those who had smoked more than 10 pack-years). Personal history of hypertension more than 5 years was also associated (odds ratio=5.0,95% confidence interval^ 1.1-22.8) with a significantly (p=0.036) increased risk for the development of fibromuscular dysplasia. HLA-DRw6 antigen was more common in the 33 fibromuscular dysplasia patients than in the 61 renal transplant donor control subjects (odds ratio=3.00, /?=0.067) or a second group of 934 ambulatory control subjects (odds ratio=2.51, p=0.03l). Adjustment for cigarette smoking increased the odds ratio to 5.0 (95% confidence interval=1.3-19.6). There was a positive though not statistically significant (odds ratio=1. Received November 15, 1988; accepted in revised form June 30, 1989. has yet to be determined. The most commonly mentioned putative etiologic factors include exposure to exogenous estrogens, mechanical stress to the renal arteries, and genetic predisposition. However, these suggestions have primarily been derived from patterns noted in single case reports and case series. A better understanding of the factors responsible for the etiology of FMD would provide a rational basis for planning strategies to prevent FMD. With this in mind, we conducted a casecontrol study of etiologic factors in FMD. Our study was primarily designed to examine the etiologic roles of: 1) oral contraceptive administration and markers of sex hormone function, 2) mechanical stress to the renal arterial wall resulting from excessive mobility of the kidneys, 3) genetic predisposition, 4) cigarette smoking, and 5) history of cardiovascular disease in patients or their families.

Anatomic variations in the major arteries of the upper extremities have been reported in 11-24.4% of individuals. In a review of 100 upper extremity arteriograms, we found an overall incidence of 9%. High origin of the radial artery from the brachial artery was the most frequently encountered anomaly occurring in 7% of individuals and accounting for 78% of all anatomic variations. Origin of the radial and ulnar arteries from the axillary artery was an infrequent finding occurring in only 2% of extremities.

Retrospective analysis of 36 embolization procedures in 29 patients with gastrointestinal bleeding was undertaken, and the presence or absence of coagulopathy was identified as a major factor affecting embolization outcome. Embolization was successful in 18 of 29 (62%) patients and unsuccessful in 11 (38%). Eight of 11 failures (73%) occurred in patients with a coagulopathy, whereas three patients (27%) in whom embolization was successful also had a coagulopathy. Embolization was 2.9 times more likely to be unsuccessful (P = .0463) and death from bleeding after embolization was 9.6 times more likely to occur (P = .0065) in patients with a coagulopathy than in those without. Because embolization was successful in six of 14 (43%) coagulopathy patients, the authors advocate embolization in patients with gastrointestinal bleeding and coagulopathy, while all efforts to correct the coagulopathy would be made as early as possible.

Venography of 44 recurrent varicoceles in 37 patients demonstrated different anatomical patterns of recurrence in surgical patients (26) compared to those treated by percutaneous balloon occlusion (18). The 3 types of patterns identified included parallel, renal vein and transcrotal collateral pathways. Virtually all surgical recurrences were owing to mid retroperitoneal (27 per cent) or low (inguinal) parallel collaterals (58 per cent). The majority of post-balloon occlusion recurrences were due to either high retroperitoneal parallel (44 per cent) or renal vein collaterals (28 per cent). Surgical recurrences were treated easily with percutaneous balloon occlusion. However, 39 per cent of the patients with recurrences following balloon embolization were not anatomical candidates for repeat percutaneous occlusion. We conclude that venous collaterals are identified easily by renal venography, and knowledge of these collaterals is helpful in planning further surgical or radiological treatment.

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Four patients with intrahepatic arterial aneurysms were treated with transcatheter embolization. Two patients had multiple aneurysms, and two had single aneurysms; in two the aneurysms were post-traumatic, and in the other two they were mycotic. Either Gelfoam or isobutyl-2-cyanocrylate was used to occlude the hepatic artery branches. It is concluded that transcatheter embolization is a safe and effective method for the management of these aneurysms and can be used as an alternative to surgery.

Four patients with aneurysms of the inferior pancreaticoduodenal artery are described. All had occlusion of the celiac axis at its origin, with the inferior pancreaticoduodenal arcades serving as a collateral pathway. We propose that the association of the celiac axis occlusion and aneurysms in the collateral supply via the pancreatic arcades is more than coincidental. Awareness of this relationship may be of significance in planning therapeutic intervention.

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