Extrarenal fibromuscular hyperplasia

doi:10.1016/0002-9610(66)90002-X

The American Journal of Surgery

Volume 112, Issue 2, August 1966, Pages 149-155

https://doi.org/10.1016/0002-9610(66)90002-X Get rights and content

Abstract

Clinical, radiologic, and pathologic studies on nineteen patients with lesions in the extrarenal arteries that resembled fibromuscular hyperplasia are described. In eleven patients fibromuscular hyperplasia was present in the renal arteries. Patients with involvement of the celiac artery were the only ones who had symptoms of visceral ischemia. Fibromuscular hyperplasia of the internal carotid arteries was observed in six patients, two of whom had symptoms of cerebral ischemia. Nine patients with fibromuscular hyperplasia of the carotid or renal arteries had intracranial aneurysms, and in two others intracranial hemorrhage developed in the absence of demonstrable aneurysms.

The histologic similarities between intracranial aneurysms and other types of aneurysms that appear in patients with fibromuscular hyperplasia, the frequency of intracranial aneurysms in patients with extracranial fibromuscular hyperplasia, and the similar sex and age incidence suggest a common etiologic origin.

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Cited by (106)

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2014, Journal of Cardiology Cases
Citation Excerpt :
One month after angioplasty, the patient could walk without claudication (grade 0; Rutherford classification). Wylie et al. reviewed the arteriograms of 70 patients with renal FMD and found that 4 of the 70 (5.7%) patients had involvement of the external iliac arteries, but their cases were all asymptomatic [6]. Symptomatic iliac FMD is rare, and most cases of iliac FMD can be diagnosed after the diagnosis of renal FMD.
A 71-year-old woman was admitted with a 6-month history of lower limb intermittent claudication. She had well-controlled hypertension and no other risk factor of atherosclerosis. Angiographic findings revealed the “string of beads” pattern in bilateral renal arteries and external iliac arteries. She was diagnosed with combined renal and iliac fibromuscular dysplasia (FMD) and underwent balloon angioplasty for bilateral external iliac arteries. Angiography did not accurately show the severity of stenosis and the location of intraluminal obstruction. In contrast, intravascular ultrasound (IVUS) with pressure gradient measurements using a wire clearly identified the primary site of stenosis and determined the treatment efficiency. In conclusion, FMD of the external iliac arteries was successfully treated by balloon angioplasty guided by IVUS and pressure wire measurements.
<Learning objective: External iliac artery fibromuscular disease is relatively rare. Angiography is effective for diagnosing this disease; however, angiography has limitations in terms of plaque characterization, measurement of vessel size, and determination of procedural end. In this study, a case of a 71-year-old woman with FMD of the external iliac arteries was successfully treated with balloon angioplasty guided by IVUS and pressure wire gradient measurements.>
Symptomatic fibromuscular dysplasia of the external iliac artery
2012, Annals of Vascular Surgery
The aim of this article is to report a case of symptomatic fibromuscular dysplasia (FMD) involving the external iliac arteries (EIAs). An 88-year-old woman was admitted to the vascular service, with a painful right posterior ankle ulcer that had progressively worsened during the course of a month. Her medical history included diabetes and hypertension. Bilateral lower-extremity pulses were absent, and femoral and tibial Doppler waveforms were monophasic. Pelvic and bilateral lower-extremity angiograms were obtained, which revealed findings in both EIAs consistent with a diagnosis of extrarenal FMD. Percutaneous transluminal angioplasty with subsequent stenting of the right EIA was performed, using a self-expanding stent. Completion digital subtraction angiography demonstrated a widely patent right EIA with brisk flow of contrast across the stent. Postprocedural arterial duplex scan showed a biphasic waveform pattern in the common femoral artery. FMD can involve the EIA and be associated with critical limb ischemia. FMD of the EIA responds well to endovascular management.
Spontaneous dissection of the iliac artery in a patient with fibromuscular dysplasia
2010, Annals of Vascular Surgery
Citation Excerpt :
FMD (disease) was described by Leadbetter and Burkland5 in 1938 and has long been considered specific to the renal arteries. Several extrarenal sites, including the abdominal, cervicocephalic, iliac, femoral, and popliteal arteries, have been reported since 1964.6-11 FMD involves, less frequently, the iliac arteries.
A 49-year-old man was referred to our hospital at 10 days after the onset of sudden intermittent claudication of the right lower limb and with right lower abdominal pain. Diagnosis by computed tomography scan and pelvic angiography was dissection from the common iliac artery to peripheral external iliac artery with thrombosed false lumen. Replacement of the common and external iliac artery was performed using a 10-mm Dacron prosthesis. A pathological examination of the right common iliac artery revealed an arterial disorder caused by fibromuscular dysplasia.
Abdominal angina
2009, American Journal of the Medical Sciences
Citation Excerpt :
The various causes of abdominal angina are summarized in Table 1. In rare cases, chronic mesenteric ischemia may be associated with vasculitis, fibrodysplasia, or radiation.23–25 Radiation enteritis develops in patients who receive 4500 cGy or more of radiation.26
Abdominal angina is an underrecognized cause of postprandial abdominal pain and weight loss. Diagnosis is often delayed and requires both a careful exclusion of more common causes and a high degree of clinical suspicion, based on the patient’s age, the coexistence of multiple risk factors for atherosclerosis, and the presence of vasculopathy in other districts. Appropriate investigations include duplex ultrasound, traditional angiography, magnetic resonance angiography, computed tomography angiography, and tonometry. The purpose of this review is to discuss the pathophysiology and clinical presentation of chronic mesenteric ischemia and to suggest a diagnostic flowchart for this complex condition.
Thirty-eight cases of dysplasia of the superior mesenteric artery
2005, Journal des Maladies Vasculaires
Si les lésions dysplasiques des artères rénales et cervicales sont parfaitement connues, il n’en est pas de même pour les atteintes de l’artère mésentérique supérieure (AMS), qui ont de plus un profil original. Peu nombreuses sont les séries exposant les différentes expressions de l’affection. Trente-huit observations personnelles nous permettent d’en préciser les caractères et de les confronter aux données de la littérature. Ces lésions de la paroi artérielle non athéromateuses et non inflammatoires s’intègrent soit dans le cadre d’une maladie fibro-musculaire (30/38) dont la cause est inconnue à ce jour, soit dans le cadre d’affections génétiques telles que la neurofibromatose (3/38) ou la maladie d’Ehlers-Danlos (5/38). La maladie fibro-musculaire (MFM) se présente sous trois aspects ayant des caractères spécifiques. a/Les lésions sténosantes s’observent le plus souvent chez la femme, et leur morphologie est différente de celle des autres localisations de la MFM (en règle associée) : sténose irrégulière diffuse, qui est découverte à l’occasion d’une hypertension artérielle (HTA), ou d’une symptomatologie digestive ischémique (6 cas sur 14). b/Les anévrismes ont également une prédominance féminine, mais sont moins fréquemment associés à d’autres dysplasies. Ces anévrismes sont le plus souvent dans notre expérience sacciformes. Contrastant avec les données de la littérature, nous n’avons observé qu’une seule rupture sur 8 cas. La découverte de l’anévrisme a ainsi été faite lors du bilan de douleurs abdominales ou d’une HTA. c/La 3^e variété de MFM concerne les dissections qui s’observent dans une population masculine, et qui, sauf dans un cas de localisation segmentaire, se traduisaient dans nos sept autres cas par une symptomatologie digestive ischémique, 4 fois bruyante, nécessitant un geste urgent. Deux affections génétiques ont été observées. a/La neurofibromatose réalise une dysplasie analogue à la MFM, mais avec des formations nerveuses pariétales anormales. Sur les 3 cas observés, 1 avait une atteinte isolée des artères viscérales, et les 2 autres, une coarctation thoraco-abdominale. b/Dans le cadre du syndrome d’Ehlers-Danlos, nous avons pris en charge 5 malades ayant une atteinte de l’AMS. Dans 3 cas de dilatation fusiforme de l’AMS et dans 1 cas de petits anévrismes étagés du tronc artériel, il n’a été fait qu’une surveillance. Un seul anévrisme évolutif était donc traité, par exérèse et greffe veineuse. Les revascularisations chez ces sujets jeunes ont été le plus souvent effectuées par matériel autogène, avec un pronostic favorable. Une embolisation a été faite avec succès pour un anévrisme sacciforme. En conclusion, une dysplasie de l’AMS présente des traits originaux, qu’il y a lieu de bien connaître pour pouvoir évoquer cette affection, non exceptionnelle, chez un sujet jeune, voire un enfant, en particulier devant un abdomen aigu réclamant un traitement urgent. (J Mal Vasc 2005 ; 30 : 150-161)
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 wich 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 hypertention, 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. (J Mal Vasc 2005; 30: 150-161)
Pathogenesis, natural history, and treatment of unruptured intracranial aneurysms
2004, Mayo Clinic Proceedings
Citation Excerpt :
Multiple aneurysms occur in 20% to 25% of patients with saccular aneurysms, and approximately 20% of patients with saccular aneurysms have a family history of SAH or intracranial aneurysms.14 Various other pathological entities have been associated with intracranial aneurysms including arteriovenous malformations (AVMs),15–19 polycystic kidney disease,20–22 coarctation of the aorta,23,24 fibromuscular dysplasia,25–28 Marfan syndrome,29 moyamoya disease,30–34 Ehlers-Danlos syndrome,35,36 pseudoxanthoma elasticum,37 and pituitary gland tumors.5 The underlying pathophysiology leading to the development of intracranial aneurysms has long been a subject of controversy.
Unruptured intracranial aneurysms (UIAs) are a major public health issue. These lesions have become increasingly recognized in recent years with the advent of advanced cerebral imaging techniques. Epidemiological evidence from multiple sources suggests that most intracranial aneurysms do not rupture. Therefore, it is desirable to identify which UIAs are at greatest risk of rupture when considering which to repair. It is important to compare size-, site-, and group-specific natural history rates with size-, site-, and age-specific morbidity and mortality associated with UIA repair because increased natural history risk often is associated with increased risk of aneurysm repair. Patient age is crucial in decision making because of its major effect on operative morbidity and mortality; however, it does not substantially affect natural history. The effect of age is most notable in patients about 50 years of age and older for open surgery and about 70 years of age and older for endovascular procedures. In general, rupture risk is lowest for patients in asymptomatic group 1 (no history of subarachnoid hemorrhage) with UIAs less than 7 mm in diameter in the anterior circulation. Surgical morbidity and mortality are most favorable for asymptomatic patients younger than 50 years who have UIAs less than 24 mm in diameter in the anterior circulation and no history of ischemic cerebrovascular disease. Endovascular morbidity and mortality may be less age dependent, and this could favor endovascular procedures, particularly in patients aged 50 to 70 years. An important issue is determining immediate vs long-term risk regarding treatment effectiveness and durability. This issue emphasizes the importance of long-term follow-up in patients after surgical and endovascular procedures.

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^☆: Presented at the annual meeting of the Pacific Coast Surgical Association, Palm Springs, California, February 20–23, 1966.

¹: From the Departments of Surgery and Radiology, University of California School of Medicine, San Francisco, California.

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Scientific paperExtrarenal fibromuscular hyperplasia☆

Abstract

Lancet

Fibromuscular hyperplasia of the renal arteries

Ann. Surg.

Fibromuscular hyperplasia of the internal carotid artery

Ann. Surg.

Aneurysms and anatomical variation of cerebral arteries

Arch. Path.

A systemic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956

J. Neuropath. & Exper. Neurol.

Intracranial Arterial Aneurysms

A follow-up examination of 138 cases of subarachnoid hemorrhage

Acta med. scandinav.

Subarachnoid Haemorrhage

Scientific paper
Extrarenal fibromuscular hyperplasia☆