Fibromuscular dysplasia

Diagnosis

The doctor may check for fibromuscular dysplasia if they detect an abnormal sound in the upper stomach area or neck, which could indicate narrowed arteries. Even in the absence of symptoms, individuals with a family history of fibromuscular dysplasia or aneurysms may be recommended to undergo screening.

To diagnose the condition, the doctor will conduct a physical examination and order blood tests, including assessments of blood sugar and cholesterol levels, to detect signs of atherosclerosis, another condition that can lead to arterial narrowing.

Diagnostic tests for fibromuscular dysplasia may include the following:

• Duplex ultrasound: This noninvasive imaging test employs a transducer pressed against the skin to send sound waves into the body. By reflecting off cells and body structures, the waves provide information on blood flow speed, as well as the size and shape of blood vessels, helping to determine if an artery is narrowed.
• CT angiogram: This test generates cross-sectional images of the body, which can reveal arterial narrowing, aneurysms, and dissections. The individual lies on a narrow table that moves through a doughnut-shaped scanner. Prior to the procedure, a dye is injected to enhance visualization of the examined areas.
• Magnetic resonance (MR) angiogram: By utilizing a magnetic field and radio waves, this test produces images of the body to identify aneurysms or dissections. The person lies on a narrow table that slides into a tube-like machine with open ends. A dye injection may be administered before the procedure to highlight the examined areas.
• Catheter-based angiography: This commonly employed test involves inserting a thin tube (catheter) into an artery and maneuvering it to the desired examination site. A small amount of dye is injected, and X-rays are used to examine the area.

After receiving a diagnosis of fibromuscular dysplasia, your doctor will provide ongoing clinical care. In certain instances, such as the presence of an aneurysm or if your symptoms undergo any changes, repeat imaging may be necessary to monitor the condition of your arteries.

Treatment

Treatment for fibromuscular dysplasia (FMD) varies depending on the symptoms, location of the narrowed artery, and other concurrent health conditions like high blood pressure. In cases where immediate treatment is unnecessary, doctors may advise a strategy of watchful waiting. Unfortunately, there is currently no cure for FMD. Therefore, treatment primarily revolves around managing symptoms and minimizing the risk of complications.

Medications

For individuals with fibromuscular dysplasia and hypertension, treatment with high blood pressure medications is highly recommended, even if they have undergone a procedure to correct the condition. There are several types of medications available for this purpose:

• Angiotensin-converting enzyme (ACE) inhibitors: Examples include benazepril (Lotensin), enalapril (Vasotec), and lisinopril (Prinivil, Zestril). These medications help relax the blood vessels.
• Angiotensin II receptor blockers: These drugs, such as candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), and valsartan (Diovan), also help relax the blood vessels.
• Diuretics: Hydrochlorothiazide (Microzide) is an example of a diuretic. These medications aid in removing excess fluid from the body and are often used in combination with other blood pressure medications.
• Calcium channel blockers: Amlodipine (Norvasc), nifedipine (Procardia), and other medications in this class help relax the blood vessels.
• Beta blockers: Metoprolol (Lopressor), atenolol (Tenormin), and other beta blockers slow down the heartbeat and block the effects of adrenaline.

In addition to the mentioned medications for high blood pressure in individuals with fibromuscular dysplasia, your doctor may suggest daily aspirin to lower the risk of stroke, but it’s crucial to consult your doctor before starting aspirin. Some blood pressure medications can impact kidney function, so your doctor may recommend regular blood and urine tests to monitor kidney function after starting these medications.

Surgery or other procedures

• Percutaneous Transluminal Angioplasty (PTA). Is a commonly preferred procedure over surgery for treating narrowed arteries. Typically performed along with a catheter-based angiogram, PTA involves injecting dye into an artery to identify narrowed areas. A wire is then guided to the affected artery, and a balloon catheter is inserted to open the narrowed section by inflating the balloon. In some cases, a stent (metal mesh tube) may be placed within the weakened part of the artery to provide additional support and prevent rupture.
• Surgical revascularization. Is not commonly recommended and is usually reserved for cases where complications arise or if PTA is not feasible. This invasive approach involves repairing or replacing the narrowed portion of the artery through surgery. The specific surgical technique employed depends on the location of the narrowed artery and the extent of damage it has incurred.