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Fibromuscular dysplasia of arteries

Orpha number ORPHA336
Synonym(s) -
Prevalence Unknown
Inheritance Unknown
Age of onset Adult
ICD-10
  • I77.3
ICD-O -
OMIM
UMLS
  • C0016052
  • C1851111
MeSH
  • C537929
  • D005352
MedDRA
  • 10054794

Summary

Fibromuscular dysplasia (FMD), formerly called fibromuscular fibroplasia, is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries. The prevalence of FMD is not precisely known. The prevalence of symptomatic renal artery FMD is about 1 in 250 and the prevalence of cervicocranial FMD is probably half that. The prevalence of carotid artery dissection in the general population is about 1 per 100,000. Histological classification discriminates three main subtypes, intimal, medial and perimedial, which may be associated in a single patient. Angiographic classification includes the multifocal type, with multiple stenoses and the 'string-of-beads' appearance that is related to medial FMD, and tubular and focal types, which are not clearly related to specific histological lesions. Renovascular hypertension is the most common manifestation of renal artery FMD. Multifocal stenoses with the 'string-of-beads' appearance are observed at angiography in more than 80% of cases, mostly in women aged between 30 and 50 years; they generally involve the middle and distal two-thirds of the main renal artery and in some case also renal artery branches. Cervicocranial FMD can be complicated by dissection with headache, Horner's syndrome or stroke, or can be associated with intracerebral aneurysms with a risk of subarachnoid or intracerebral hemorrhage. The etiology of FMD is unknown, although various hormonal and mechanical factors have been suggested. Subclinical lesions are found at arterial sites distant from the stenotic arteries, and this suggests that FMD is a systemic arterial disease. It appears to be familial in 10% of cases. Noninvasive diagnostic tests include, in increasing order of accuracy, ultrasonography, magnetic resonance angiography and computed tomography angiography. The gold standard for diagnosing FMD is catheter angiography, but this invasive procedure is only used for patients in whom it is clinically pertinent to proceed with revascularization during the same procedure. Differential diagnosis include atherosclerotic stenoses and stenoses associated with vascular Ehlers-Danlos and Williams' syndromes, and type 1 neurofibromatosis. Management of cases with renovascular hypertension includes antihypertensive therapy, percutaneous angioplasty of severe stenoses, and reconstructive surgery in cases with complex FMD that extends to segmental arteries. The therapeutic options for securing ruptured intracerebral aneurysms are microvascular neurosurgical clipping and endovascular coiling. Stenosis progression in renal artery FMD is slow and rarely leads to ischemic renal failure.

Expert reviewer(s)

  • Pr Pierre BOUTOUYRIE
  • Pr Anne-Paule GIMENEZ-ROQUEPLO
  • Pr Xavier JEUNEMAITRE
  • Dr Agnès LABATIDE-ALANORE
  • Dr Jérôme PERDU
  • Pr Pierre-François PLOUIN

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Detailed information

Review article
  • EN (2007)
Clinical practice guidelines
  • FR (2011,pdf)
Article for general public
  • FR (2012,pdf)
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