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Gavalas M, Meisner R, Labropoulos N, Gasparis A, Tassiopoulos A. Renal infarction complicating fibromuscular dysplasia. Vasc Endovascular Surg 2014; 48:445-51. [PMID: 25227972 DOI: 10.1177/1538574414551206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and extracranial carotid arteries. We present 3 cases of renal infarction complicating renal artery FMD in 42-, 43-, and 46-year-old females and provide a comprehensive review of the literature on this topic. In our patients, oral anticoagulation therapy was used to treat all cases of infarction, and percutaneous angioplasty was used nonemergently in one case to treat refractory hypertension. All patients remained stable at 1-year follow-up. This is consistent with outcomes in previously published reports where conservative medical management was comparable to surgical and interventional therapies. Demographic differences may also exist in patients with renal infarction and FMD. A higher prevalence of males and a younger age at presentation have been found in these patients when compared to the general population with FMD.
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Affiliation(s)
- M Gavalas
- Department of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - R Meisner
- Department of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - N Labropoulos
- Department of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - A Gasparis
- Department of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - A Tassiopoulos
- Department of Vascular Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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2
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Kirton A, Crone M, Benseler S, Mineyko A, Armstrong D, Wade A, Sebire G, Crous-Tsanaclis AM, deVeber G. Fibromuscular dysplasia and childhood stroke. Brain 2013; 136:1846-56. [DOI: 10.1093/brain/awt111] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brasseur B, Chantrain CF, Godefroid N, Sluysmans T, Anslot C, Menten R, Clapuyt P, Dupont S, Vermylen C, Brichard B. Development of renal and iliac aneurysms in a child with generalized infantile myofibromatosis. Pediatr Nephrol 2010; 25:983-6. [PMID: 19997940 DOI: 10.1007/s00467-009-1393-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 10/17/2009] [Accepted: 10/20/2009] [Indexed: 10/20/2022]
Abstract
Infantile myofibromatosis is a rare disorder characterized by the formation of tumors in the skin, soft tissues, bone, and viscera. We report the case of a 3-week-old girl who presented with severe hypertension due to generalized infantile myofibromatosis including renal involvement. The infant was treated by chemotherapy and showed progressive regression of the tumors. However, her evolution was marked by the development of aneurismal dilations of the renal and iliac arteries as observed in fibromuscular dysplasia. We discuss the possibility of a link between these two mesenchymal disorders.
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Affiliation(s)
- Benoit Brasseur
- Department of Pediatric Hematology and Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, Brussels, Belgium
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Foa-Torres G, Ganame J, Juaneda E, Peirone A, Barcudi MS, Achaval A. Systemic hypertension and transient ischemic attack in a 6-year-old girl with fibromuscular dysplasia treated with percutaneous angioplasty. Cardiovasc Intervent Radiol 2009; 33:173-6. [PMID: 19367433 DOI: 10.1007/s00270-009-9562-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 03/08/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
Abstract
We describe a 6-year-old girl with arterial hypertension secondary to fibromuscular dysplasia with stenoses of both renal arteries and transient ischemic attack due to extracranial right internal carotid artery subtotal occlusion as well as left internal carotid artery stenosis. She was treated with percutaneous angioplasty of both renal and both carotid arteries.
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Abstract
Renovascular disease is an uncommon but important cause of hypertension in children. It is usually diagnosed after a long delay because blood pressure is infrequently measured in children and high values are generally dismissed as inaccurate. Many children with renovascular disease have abnormalities of other blood vessels (aorta, cerebral, intestinal, or iliac). Individuals suspected of having the disorder can be investigated further with CT, MRI, or renal scintigraphy done before and after administration of an angiotensin-converting-enzyme inhibitor, but angiography is still the gold standard. Most children with renovascular disease will need interventional or surgical treatment. Endovascular treatment with or without stenting will cure or reduce high blood pressure in more than half of all affected children. Surgical intervention, if needed, should be delayed preferably until an age when the child is fully grown. Modern treatment provided by a multidisciplinary team of paediatric nephrologists, interventional radiologists, and vascular surgeons offers good long-term treatment results.
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Affiliation(s)
- Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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6
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Virmani R, Burke AP, Taylor AJ. Congenital Malformations of the Vasculature. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cormier F, Cormier JM. Trente-huit cas de lésions dysplasiques de l’artère mésentérique supérieure. ACTA ACUST UNITED AC 2005; 30:150-61. [PMID: 16142179 DOI: 10.1016/s0398-0499(05)83832-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Dysplasia of the renal and cervical arteries are well known, but dysplasia of the superior mesenteric artery (SMA) is less frequent and has specific presentation. There have been few reports on the different types of presentations. We report a series of 38 cases and present the characteristic features together with a comparison with data in the literature. These non-atheromatous non-inflammatory lesions of the arterial wall occurred either in a context of fibromuscular disease which cause is unknown (30/38 patients) or in patients with genetic disease such as neurofibromatosis (3/38) or Ehlers-Danlos disease (5/38). The fibromuscular disease presented three aspects with specific characteristics. a) stenosing lesions found predominantly in women with a different morphology than in the other localization (usually associated): irregular diffuse stenosis discovered in patients with hypertension, or ischemic digestive symptoms (6/14 patients). b) Aneurysms, also found predominantly in women, but less frequently associated with other dysplasias. These aneurysms were generally sacciform. Unlike data in the literature, our series only included rupture in 1/8 cases. The aneurysm was discovered during the exploration of abdominal pain or hypertension. c) The third type of fibromuscular disease concerned dissections which were observed in the male population, (except one case of segmental dysplasia), and presented with signs of digestive ischemia in the other seven patients, four in an emergency context requiring immediate treatment. Two genetic diseases were observed. a) Neurofibromatosis led to dysplasia analogous to fibromuscular disease, but with abnormal nerve formations in the wall. For the three cases observed, one involved only the visceral arteries and the two others thoraco-abdominal coarctation. b) We had five patients with Ehlers-Danlos syndrome, with dysplasia of the superior mesenteric artery. For three there was a fusiform dilatation and in one small aneurysms along the arterial trunk, which only required surveillance. There was only one aneurysm which required treatment by resection and venous graft. In these young patients, revascularization was generally achieved with autologous material and the prognosis was favorable. Embolization was successful in treating the sacciform aneurysm in one patient. In conclusion, dysplasia of the superior mesenteric artery has a specific presentation which must be recognized to enable diagnosis of this not uncommon condition in young subjects (even children) who often present with an acute abdomen requiring urgent treatment.
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Affiliation(s)
- F Cormier
- Clinique G. Bizet, 23 rue Georges Bizet, 75 116 Paris
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Honnef D, Staatz G, Mahnken AH, Hannig U, Günther RW. Percutaneous Balloon Angioplasty of Superior Mesenteric Artery Stenosis in an Adolescent. AJR Am J Roentgenol 2005; 184:S123-5. [PMID: 15728003 DOI: 10.2214/ajr.184.3_supplement.0184s123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Dagmar Honnef
- Department of Diagnostic Radiology, University of Technology of the RWTH Aachen, Pauwelsstrasse 30, Aachen 52057, Germany
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Chan FP, Rubin GD. MDCT angiography of pediatric vascular diseases of the abdomen, pelvis, and extremities. Pediatr Radiol 2005; 35:40-53. [PMID: 15692842 DOI: 10.1007/s00247-004-1371-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2004] [Revised: 09/15/2004] [Accepted: 10/25/2004] [Indexed: 12/20/2022]
Abstract
Multi-detector-row computed tomography (MDCT) enables rapid, noninvasive, high-resolution, and three-dimensional imaging of pediatric vascular diseases. In this paper, we explore the adaptation of the MDCT angiographic principles to pediatric patients for vascular diseases of the abdomen, pelvis, and extremities. Special emphasis is placed on the practical aspects of how to perform these studies. Optimizations of scan parameters, contrast medium usage, radiation dose, and three-dimensional image processing are discussed in detail. We provide practical guidance on how to choose between MR angiography and CT angiography. Finally, we review important pediatric vascular diseases, categorized into traumatic injuries, inherited vascular diseases, congenital vascular diseases, vasculitides, and surgical planning and assessment. In each category, we discuss how CT angiography can be tailored to maximize its clinical benefits.
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Affiliation(s)
- Frandics P Chan
- Department of Radiology, Stanford University Medical Center, Stanford, CA 94305-5105, USA.
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Leary MC, Finley A, Caplan LR. Cerebrovascular complications of fibromuscular dysplasia. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2004; 6:237-248. [PMID: 15096316 DOI: 10.1007/s11936-996-0019-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Patients with cerebral ischemia or hemorrhage due to fibromuscular dysplasia (FMD) should be admitted to a monitored hospital bed and receive supportive stroke care. Based on our personal clinical experience, we recommend antiplatelet agents for future stroke prevention in patients with symptomatic FMD. In patients with watershed stroke due to hemodynamically significant FMD, our opinion is that hypertensive, hypervolemic therapy should be initiated immediately. Additionally, we suggest that potential revascularization therapies, such as intraoperative or primary percutaneous angioplasty, should be discussed.
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Affiliation(s)
- Megan C. Leary
- Division of Stroke and Cerebrovascular Disease, Palmer 125, Department of Neurology
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Piechowski-Józwiak B, Bogousslavsky J. Cervicocephalic Fibromuscular Dysplasia. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Horie T, Seino Y, Miyauchi Y, Saitoh T, Takano T, Ohashi A, Yamada N, Tamura K, Yamanaka N. Unusual petal-like fibromuscular dysplasia as a cause of acute abdomen and circulatory shock. JAPANESE HEART JOURNAL 2002; 43:301-5. [PMID: 12227706 DOI: 10.1536/jhj.43.301] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory segmental arterial occlusive disorder that involves primarily the renal and carotid arteries, and less often the coronary, iliac, and visceral arteries. We report the case of 78-year-old Japanese woman who presented with acute abdomen complicated by shock. Autopsy revealed hemorrhagic necrosis of the small intestine due to severe narrowing of the mesenteric arteries. Histologically, smooth muscles showed in-bundle hyperplasia surrounding the adventitia together with medial and perimedial fibrodysplasia of these arteries, forming the characteristic petal-like appearance of FMD. No occlusive thrombus was observed. Further, another medial fibrodysplasia type of FMD was also seen in the renal and left circumflex coronary arteries. Unusual proliferation of smooth muscles resulted in the petal-like atypical FMD at the superior mesenteric artery.
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Affiliation(s)
- Tsutomu Horie
- First Department of Medicine, Nippon Medical School, Tokyo, Japan
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