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Østergaard ML, Hjort N, Buus NH, Reinhard M. Evidence for routine brain-to-pelvis imaging and antiplatelet therapy in patients diagnosed with fibromuscular dysplasia. J Clin Hypertens (Greenwich) 2024; 26:890-901. [PMID: 39012329 DOI: 10.1111/jch.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/19/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
Fibromuscular dysplasia (FMD) is a disease of the musculature of arterial walls leading to stenoses, aneurysms, and dissections. The purpose of this report was to summarize the evidence for (1) one-time routine imaging from brain-to-pelvis and (2) lifelong antiplatelet therapy, for example, aspirin, for patients diagnosed with FMD as suggested by an international consensus report from 2019. PubMed was systematically searched, and the evidence providing a basis for the current consensus points, as well as articles published since, were reviewed. In four registries evaluating patients with FMD, the prevalence of multivessel involvement, aneurysms, and dissections was reported to be 43.5%-66.3%, 21.6%-30.6%, and 5.6%-28.1%, respectively. Any antiplatelet drug was used in 72.9% of patients, and aspirin was prescribed in up to 70.2% of patients. Based on the high prevalence of vascular manifestations, their associated morbidity, and the potential for endovascular or surgical intervention, the suggestion of one-time brain-to-pelvis screening with computed tomography angiography or magnetic resonance angiography is well supported. Contrarily, the evidence to support the consensus statement of lifelong antiplatelet therapy to all patients in the absence of contraindications is more uncertain since a beneficial effect has not been demonstrated specifically in patients with fibromuscular dysplasia. Therefore, until the efficacy and safety of primary thromboprophylaxis have been demonstrated in this patient group specifically, it may be equally appropriate to only use antiplatelet agents in patients with a clear indication after individual evaluation according to risk factors for thrombotic and thromboembolic complications.
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Affiliation(s)
- Mikkel Landgraff Østergaard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Niels Hjort
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Mark Reinhard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Lu YT, Zhou ZM, Zhang D, Sun L, Liu XC, Yang YK, Jiang XJ, Zhou XL. Percutaneous Transluminal Renal Angioplasty for Fibromuscular Dysplasia and Prognostic Risk Factors: A Retrospective Chinese Cohort Study. J Clin Med 2022; 12:jcm12010023. [PMID: 36614824 PMCID: PMC9821653 DOI: 10.3390/jcm12010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease involving small-to-medium-sized arteries. The characteristics of Chinese patients with FMD remain unclear. We retrospectively analyzed the data of patients with renal FMD who underwent percutaneous transluminal renal angioplasty (PTRA) for the first time at Fuwai Hospital between 2010 and 2021. The variables were selected through least absolute shrinkage and selection operator regression (LASSO), and logistic regression models were constructed to identify independent risk factors. A total of 116 patients (52 males, median age at diagnosis, 25.0 years) were enrolled. Elevated blood pressure was the leading complaint. After a median follow-up period of 18.0 months (interquartile range: 6.0-48.0 months), hypertension recurred in 34 patients and restenosis in nine patients, among whom four patients underwent secondary intervention and one patient underwent surgical revascularization. Bilateral renal artery involvement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.11-6.15; p = 0.028) and age at hypertension onset (OR: 0.93, 95% CI: 0.88-0.99; p = 0.018) were independent prognostic factors for adverse outcomes. The results indicate that patients with bilateral renal artery involvement and younger age at hypertension onset are more likely to have poorer clinical outcomes after PTRA, and should be more closely monitored.
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Affiliation(s)
- Yi-Ting Lu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ze-Ming Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Di Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Sun
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xin-Chang Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yan-Kun Yang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiong-Jing Jiang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: ; Tel.: +86-10-8839-2162
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Skræddergaard A, Nyvad J, Christensen KL, Hørlyck A, Mafi HM, Reinhard M. Difficulty and importance of diagnosing stenosis of renal branch artery in fibromuscular dysplasia: a case report. Blood Press 2021; 30:416-420. [PMID: 34697979 DOI: 10.1080/08037051.2021.1993735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 16-year-old patient presented with abdominal pain and sustained hypertension. Thorough evaluation including renography with and without captopril and renal vein renin sampling were normal. Duplex ultrasound, however, raised suspicion of a renal artery stenosis. This was confirmed by computed tomography angiography which showed a severe branch artery stenosis with post-stenotic dilatation consistent with focal fibromuscular dysplasia (FMD). As the hypertension was resistant to 3 classes of antihypertensive treatment, percutaneous transluminal renal angioplasty (PTRA) was offered. The procedure had immediate effect on the blood pressure. Without medication the patient remains normotensive 4 years after and the abdominal pain has only sporadically returned. The presented case illustrates the challenging process of diagnosing FMD-related renal branch artery stenosis as well as the potential benefits of PTRA in this patient group.
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Affiliation(s)
- Andreas Skræddergaard
- Department of Renal Medicine and the Clinic of Hypertension, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Nyvad
- Department of Renal Medicine and the Clinic of Hypertension, Aarhus University Hospital, Aarhus, Denmark
| | - Kent Lodberg Christensen
- Department of Cardiology and the Clinic of Hypertension, Aarhus University Hospital, Aarhus, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mark Reinhard
- Department of Renal Medicine and the Clinic of Hypertension, Aarhus University Hospital, Aarhus, Denmark
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Diao YP, Wu ZY, Lu CR, Chen ZG, Li YJ. Retrograde Recanalization for Proximal Occlusion of the Right Renal Artery through a Compensated Collateral Artery in a 10-year-old Patient. Ann Vasc Surg 2021; 78:379.e1-379.e5. [PMID: 34481882 DOI: 10.1016/j.avsg.2021.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND To describe a retrograde recanalization for the proximal occluded lesion in right renal artery (RRA) in young patient with fibromuscular dysplasia (FMD). METHODS A 10-year-old girl presented to our hospital with proximal RRA occlusion and refractory hypertension though she took anti-hypertension medicines. Her renin and aldosterone were beyond the normal level in both base state and excited state. Her glomerular filtration rate at right kidney was only 18.4 ml/min. Angiography revealed proximal RRA occlusion and a compensated collateral artery (CCA) from the infrarenal aorta to the RRA. She was thus diagnosed with focal FMD. A retrograde recanalization was performed through this CCA. RESULTS Angioplasty and stenting were successfully performed to treat the proximal RRA occlusion. Postoperatively, the glomerular filtration rate in the right kidney improved. One-year follow-up revealed that, the blood pressure maintained at normal range without any antihypertensive agents. No other discomfort was complained. CONCLUSIONS It is feasible to establish a working pathway with patient's compensated collateral artery to treat the renal artery occlusion.
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Affiliation(s)
- Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Cheng-Ran Lu
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China.
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A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient. SRP ARK CELOK LEK 2021. [DOI: 10.2298/sarh210303080s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. The renal artery and segmental renal artery pseudoaneurysm is a
rare and usually asymptomatic vascular lesion which in most of the cases
thrombose spontaneously, but at same time it can be a source of
life-threatening hemorrhage and shock. Today, these pseudoaneurysms are
discovered with increasing frequency due to unrelated abdominal imaging or
on screening work-ups for hypertension, as well as widespread use of
angiography. Typically, they are seen in patients after trauma,
inflammation, or renal surgery or biopsy. Case outline. In our case, a
52-year-old male patient with no prior history of surgery, significant
abdominal trauma and systemic disease, presented with left flank pain and
signs of hypovolemic shock that manifested before the admission in the
surgical emergency room. The CT scan promptly demonstrated rupture of large
retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The
angiography confirmed the rupture of the renal artery pseudoaneurysm. The
patient had the urgent operation. A life-saving nephrectomy was performed
while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated.
The fourteen days after surgery the patient was discharged fully recovered,
with normal diuresis and serum levels of creatinine and urea within
referential values. During the period of hospitalization, he was diagnosed
and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the
following hemorrhage into the intraperitoneal cavity and retroperitoneum is
a life-threatening condition, as proven with this case in which hypovolemic
shock manifested before the admission. We would like to highlight the
importance of high blood-pressure control and the importance of regular
check-ups.
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