Fibromuscular dysplasia of the renal artery responsible for renovascular hypertension: a histological presentation based on a series of 102 patients

Vuong, P. N.; Desoutter, P; Mickley, V.; Bültmann, B; Rothenberger-Janzen, K; Guyot, Hugues; Janzen, Jan

doi:10.1024/0301-1526.33.1.13

Cited by 17 publications

(16 citation statements)

References 14 publications

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“…In our study, the right renal artery was more commonly affected by FMD than the left, as previously shown. 4 As cigarette smoking may be a risk factor for FMD, 30 it is interesting to note that over half of our patients were smokers. This is a considerably higher figure than smoking rates in our region, which in 2000 were 18% for men and 20% for women 18-80 years of age.…”

Section: Discussionmentioning

confidence: 80%

“…FMD is a pathologic diagnosis, 4 but the characteristic changes seen on an angiogram can be used to make the diagnosis, as in previous studies. 9,23 In our study, we only have two cases with specimen diagnosis.…”

Section: Discussionmentioning

confidence: 97%

“…3 The 'gold standard' for the diagnosis of renal artery FMD is the classically abnormal renal arteriogram or a pathologic specimen. 4 When affecting the renal arteries, the FMD changes might lead to renovascular hypertension. 5 Gruntzig et al 6 demonstrated in 1974 that percutaneous transluminal renal angioplasty (PTRA) was highly effective in treating FMD in the renal arteries.…”

Section: Introductionmentioning

confidence: 99%

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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

et al. 2005

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Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but longtime follow-up is lacking. Retrospective follow-up for 7.074.7 years of 69 consecutive patients (age 44713 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge (from 174733/ 100713 to 138719/80715 mmHg; Po0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.074.7 years (140725/83712 mmHg; Po0.0001). Serum-creatinine had decreased both at 1 year (from 84728 to 75713 lmol/l; P ¼ 0.0030) and last follow-up (75716 lmol/l; P ¼ 0.0017). The number of antihypertensive drugs decreased (from 2.371.2 before PTRA to 1.471.3 at discharge and at 1 month; Po0.0001, and 1.671.5 at last follow-up; P ¼ 0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43729 vs 20741 mmHg; P ¼ 0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.977.7 vs 1.874.1 years; P ¼ 0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

et al. 2005

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“…The female preponderance of FMD suggests the importance of hormonal factors such as estrogen and progesterone 8,19,20. In one study, 16% of women with FMD had previous hypertension in pregnancy compared with 4%–5% of hypertensive pregnancies in the general population 21.…”

Section: Etiologymentioning

confidence: 99%

Optimal management of renal artery fibromuscular dysplasia

Gottsäter¹,

Lindblad²

2014

TCRM

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Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory angiopathy of unknown cause affecting medium-sized (most commonly renal) arteries and causing renovascular hypertension. The most common medial multifocal type of FMD (with the “string of beads” appearance) is more than four times more prevalent in females than in males. FMD accounts for up to 10% of cases of renovascular hypertension. Compared with patients with atherosclerotic renal artery stenosis, patients with FMD are younger, have fewer risk factors for atherosclerosis, and a lower occurrence of atherosclerosis in other vessels. The etiology is multifactorial, including vessel wall ischemia and smoking, as well as hormonal and genetic factors. Intra-arterial digital subtraction angiography is still the gold standard for exclusion or confirmation of renal artery stenosis caused by FMD, at least in young patients, who more often have lesions in branches of the renal artery. For FMD patients with atherosclerosis and those who are older (>50–55 years), significant renal artery stenosis may be confirmed or excluded with ultrasonography. The FMD lesion is typically truncal or distal, whereas atherosclerotic lesions are more often proximal or ostial. Treatment options are medical, endovascular (percutaneous transluminal renal angioplasty [PTRA]), and surgical. Invasive treatment should be considered when hypertension cannot be controlled with antihypertensive drugs and in patients with impaired renal function or ischemic nephropathy. PTRA has become the treatment of choice and normally yields good results, especially in unifocal disease and young patients. Pressure gradients are normally completely abolished, and there is no indication for stent placement. Surgical revascularization is indicated after PTRA complications; thrombosis, perforation, progressive dissection, repeated PTRA failure or restenosis. Centralization of handling is recommended.

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“…This patient had adventitial (periar- terial) hyperplasia, the least common type, for which limited angiographic information is available. 3 FMD occurs in the middle or distal arterial segments in younger patients with few cardiovascular risk factors. In contrast, atherosclerotic renal artery stenosis generally occurs at the ostium and proximal portions of the artery in older patients with typical cardiovascular risk factors.…”

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confidence: 99%

Adventitial Fibromuscular Dysplasia of the Renal Artery

Weiner

Kiernan²,

Yan³

et al. 2009

Circulation

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Fibromuscular dysplasia of the renal artery responsible for renovascular hypertension: a histological presentation based on a series of 102 patients

Abstract: With the progress in angioplasty, not all patients suffering from FMD undergo a primary surgical therapy and therefore this lesion is less seen in the daily work of the histopathologist.

Cited by 17 publications

References 14 publications

Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis

Optimal management of renal artery fibromuscular dysplasia

Adventitial Fibromuscular Dysplasia of the Renal Artery

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