Rationale:Iliac arterial fibromuscular dysplasia (FMD) was rarely reported and its demographic, clinical, and imaging features have not been precisely described resulting in uncertain therapeutic methods.Patient concerns:A 31-year-old man was referred because of 3-month-ago onset hypertension, low serum potassium, and a small-sized right kidney with normal renal artery under ultrasound examination. This patient was suspected of primary aldosteronism, whereas spirolactone was poorly effective.Diagnosis:Contrast-enhanced computed tomographic angiography (CTA) and three-dimensional reconstruction of the whole aorta discovered an aneurysm from the right common iliac artery (CIA) to the internal iliac artery, consistent with a left CIA dissection and a remarkable right renal artery aneurysm before a stenosis. Iliac and renal arteries FMD were then confirmed through digital subtraction angiography (DSA).Intervention:Percutaneous transluminal angioplasty (PTA) of right renal artery was operated and a stent was deployed in left CIA.Outcomes:This patient was normotensive, asymptomatic, and free from recurrence without any antihypertensive agents at an 8-month follow-up.Lessons:To our knowledge, this is the first bilateral common and internal iliac arterial FMD case in China, with unique asymptomatic dissection, aneurysm, and renovascular hypertension. Screening for secondary hypertension in young population and for iliac or renal arterial FMD is therefore suggested with CTA and reconstruction from neck to pelvis and MRA in those with intracranial disorders. Among youth FMD, the potential of PTRA in renovascular hypertension out of antihypertensive drugs and stent in dissection is novelly indicated.
Background: Iliac arterial fibromuscular dysplasia (FMD) is an orphan type of FMD, a non-atherosclerotic non-inflammatory arteriopathy predominantly among women aging from 20 to 60. The demographic, clinical features and therapeutic algorithm of iliac arterial FMD have not been precisely described. Patient Concerns: A 31-year-old Chinese male was referred for 3-month-ago onset hypertension, low serum potassium, and small-sized right kidney with normal renal artery under ultrasound examination. Spirolactone was poorly effective in this patient. Diagnosis: Contrast-enhanced computed tomographic angiography (CTA) and three-dimensional reconstruction of the whole aorta discovered an aneurysm from right common iliac artery (CIA) to the internal iliac artery, consistent with left CIA dissection and a remarkable right renal artery aneurysm before a stenosis, which was then confirmed through digital subtraction angiography. Intervention: Percutaneous transluminal angioplasty (PTA) of right renal artery was operated and a stent was deployed in left CIA. Outcome: This patient was normotensive, asymptomatic and free from recurrence without any antihypertensive agents at an 8-month follow-up. Conclusions: A total of 111 iliac arterial FMD cases (female, 84.7%; median age, 52±12.8 years) have been reported. Asymptomatic condition (49.5%) and claudication (40.5%) consist the majority of clinical presentations. Bruit (64.9%) and pulse deficits (39.4%) are the most popular signs. External iliac artery involved is approximate threefold of common and internal iliac arteries, usually accompanied with renal artery (71.2%, presenting hypertension) or carotid artery involvement (50.5%). A system screening among iliac or renal arterial FMD patients is therefore suggested with CTA from neck to pelvis and MRA in head. Dissection accounts for 15.3% cases, usually presenting ischemia symptoms with an inclination to young males. Conservative medication is efficient among 61.3% patients and PTA was operated in 15 patients with satisfactory outcomes in 86.7%. Stenting is an optimal recommendation of iliac artery FMD with progressive dissection. PTA is the first choice of short-duration renovascular hypertension due to FMD especially in young patient.
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