Successful Treatment of Renovascular Hypertension due to Fibromuscular Dysplasia by Intravascular Ultrasound-Guided Atherectomy

Abstract

A 22-year-old man presented with renovascular hypertension, based on a stenosis of the distal portion of the right renal artery with a ‘string of beads’-like appearance. An intravascular ultrasound image at the renal artery lesion revealed irregularity of the vascular wall. Directional atherectomy was performed and histopathology of atherectomised tissues showed medial fibroplasia, a common type of fibromuscular dysplasia. After atherectomy his hypertension was markedly improved. We report here a case of renovascular hypertension due to fibromuscular dysplasia, successfully diagnosed and treated with IVUS-guided renal atherectomy.

Renal artery stenting may not be appropriate for patients with atherosclerotic renal artery stenosis

“…Variability in inpatient mortality, incidence of complications, five-year patency, five-year mortality, and five-year dialysis-free survival was introduced using reference values from the literature. 5,7,10,12,[18][19][20][21][22][23][24][25][26][27] Variation in life expectancy was introduced using reference values in the literature and the US Census Bureau. 10,19,21 Normal distribution plots were generated from a variance-based sensitivity analysis of these factors for cost (Figure 2a) and cost þ value (Figure 2b).…”

Hypertension due to Angiodysplasia

“…Ptotic kidneys support the mechanical theory in which stretching of the renal artery may be responsible for angiodysplasia. 5 Ischemia due to inadequate nutrition of the renal artery by the vasa vasora has also been implicated. Alpha-1-antitrypsin deficiency has also been hypothesized in various disorders affecting mediumsized arteries, intracranial aneurysms, cervicocephalic arterial dissections.…”

“…6 Other modalities available in select centers are percutaneous transluminal angioplasty, vascular stent placement and surgical revascularization. 5,8,9 Contributions: All four authors were involved in patient management and review of literature. Sumanth drafted the manuscript.…”

Renal Artery Fibromuscular Dysplasia Is a Cause of Refractory Hypertension in the Elderly

“…FMD sometimes coexists with atherosclerotic renal artery stenosis 2 but can occur on its own like in our index case. Renal artery FMD has very unique findings on intravascular ultrasound that are distinct from those of renal artery stenosis 3,4 . Intravascular ultrasound can therefore establish the diagnosis of FMD which is prognostically favorable over atherosclerotic renal artery stenosis.…”

“…Renal artery FMD has very unique findings on intravascular ultrasound that are distinct from those of renal artery stenosis. 3,4 Intravascular ultrasound can therefore establish the diagnosis of FMD which is prognostically favorable over atherosclerotic renal artery stenosis. Renal artery FMD should be included in the differential diagnosis of refractory hypertension even in the older patients since recognizing and treating this condition will add favorably to the outcome of these patients.…”