Surgery

Fibromuscular Dysplasia

A rare vascular disease, fibromuscular dysplasia (FMD) can affect any artery in your body. The disease causes the blood vessel to narrow (stenosis), develop a bulge (aneurysm), and tear (dissection). Sometimes affected arteries look beaded. FMD generally appears in the arteries leading to the brain or the kidneys. If you are diagnosed with this condition, it may come as a surprise as most people have no symptoms. The condition is usually found by accident while doing an imaging test for something unrelated.  While there is no cure for FMD, we can treat it effectively. 

About Fibromuscular Dysplasia

You may not have any symptoms, but if you do, it will depend on what arteries are affected by the disease. If you have FMD in the arteries leading to your kidneys (renal), you may experience:

  • High blood pressure
  • Tissue damage in your kidneys (ischemic renal atrophy)
  • Flank pain
  • Shrinkage of the kidney
  • Chronic kidney failure (rare)

 If you have FMD in the arteries leading to your brain (carotid), you may have:

  • Headache
  • Dizziness
  • Blurred vision or temporary loss of vision
  • Pulsating ringing in your ears (pulsile tinnitus)
  • Neck pain
  • Facial weakness or numbness

If FMD is affecting the arteries in your abdomen, you may experience:

  • Abdominal pain after eating
  • Unintended weight loss

If it is in the arteries leading to your heart, you may have chest pain or, less often, a heart attack. You might also experience:

  • Dizziness
  • Headache
  • Neck pain
  • Ringing in the ears (pulsatile tinnitus)
  • Sense that the room is spinning (vertigo)
  • Swooshing sound in your ear
  • Stroke
  • Transient ischemic attack 

We do not know what causes FMD, but we suspect there is a genetic component and, because it affects more women than men, a hormonal role as well. You are at greater risk if you are in your early 50s and if you are a smoker. We are also more likely to consider FMD if you:

  • Are younger than 35 with high blood pressure
  • Get severe recurrent headaches (especially migraine)
  • Had a stroke before age 60
  • Have had a dissection or aneurysm
  • Have ringing in the ears (pulsatile tinnitus)

Diagnosis and Treatment

To diagnose FMD, we start with a physical exam and a fasting blood test to check your blood sugar and cholesterol levels. We may also use imaging tests, such as:

  • Carotid and renal artery ultrasounds use sound waves to produce pictures of your blood vessels.  
  • Doppler ultrasound helps us see if your artery is narrowed.

We use contrast dye with these imaging techniques:

  • Magnetic resonance (MR) imaging uses 3D images created by magnetic waves.
  • Computed tomography (CT) uses many X-ray measurements to provide cross-sectional images of your blood vessels.
  • Catheter-based angiogram uses X-rays to see whether you have stenosis, aneurysm, or dissection.

There is no known cure for FDM, but we can manage your symptoms. At Mount Sinai, we treat FMD with a combination of medication and surgical procedures. We use medicines to: 

  • Prevent stroke and heart attack (e.g., aspirin)
  • Treat high blood pressure
  • Stop the narrowing of your blood vessels (e.g., angiotensin II receptor blockers)
  • Remove excess fluid from your body (e.g., diuretics)
  • Relax your blood vessels with calcium channel blockers (e.g., amlodipine or nifedipine)
  • Slow your heartbeat and block adrenaline with beta blockers (e.g., metroprolol or atenolol)

We might also use minimally invasive procedures to open up the artery. Angioplasty does this with a balloon while stent placement uses a mesh tube (called a stent).

We also monitor you regularly. To make sure your condition remains stable, we may use ultrasound every 6 to 12 months. In addition, we will probably screen for aneurysms with a CT or MR angiogram.

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