Materiały źródłowe

• #1 Fibromuscular dysplasia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fibromuscular-dysplasia/symptoms-causes/syc-20352144

  Treatments are available to control symptoms and help prevent complications, such as stroke. But there is no cure for fibromuscular dysplasia. […] Fibromuscular dysplasia care at Mayo Clinic. […] Diagnosis treatment.

• #2 Diagnosis, management, and future developments of fibromuscular dysplasia – PubMed

  https://pubmed.ncbi.nlm.nih.gov/21236620/

  Fibromuscular dysplasia (FMD) is a nonatherosclerotic noninflammatory vascular disease that primarily affects women from age 20 to 60, but may also occur in infants and children, men, and the elderly. […] Treatment consists of antiplatelet therapy for asymptomatic individuals and percutaneous balloon angioplasty for patients with indications for intervention. Patients with aneurysms should be treated with a covered stent or open surgical repair. […] Little new information has been published about FMD in the last 40 years.

• #3 Fibromuscular Dysplasia

  https://www.rwjbh.org/treatment-care/heart-and-vascular-care/diseases-conditions/fibromuscular-dysplasia/

  There are several treatments available for patients with FMD. Your doctor will talk to you about the type of treatment that is best for you, based on the type of FMD you have, how severe it is, and your overall health. Treatment options for include lifestyle changes, medications, and medical and surgical procedures. […] Manage your stress. […] Make and keep appointments to see your doctor for routine check-ups and follow-up tests. […] ACE inhibitors will help blood vessels relax and open up, leading to a lower blood pressure. […] Angiotensin II receptor blockers will help blood vessels open up, leading to a lower blood pressure. […] Beta blockers will help reduce your blood pressure. […] Angioplasty […] Peripheral bypass surgery.

• #4 Fibromuscular Dysplasia Treatment & Therapies | FMD Treatment & Management Program in Northeast Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/fibromuscular-dysplasia-program/fibromuscular-dysplasia-treatment-and-management

  The best course of treatment for fibromuscular dysplasia (FMD) is different for each patient. […] For many patients, the FMD treatment plan is focused on medical therapy (for blood pressure control and to prevent blood clots) managing symptoms and monitoring the disease. […] Some patients with FMD will need a vascular procedure, such as a kidney artery angioplasty or treatment of an aneurysm. […] Medical therapies for patients with FMD are important for management of FMD-related symptoms, control of blood pressure, and to prevent complications. […] In order to prevent blood clot formation, your physician may prescribe an antiplatelet medications, such as aspirin or clopidogrel. […] For patients experiencing high blood pressure due to renal artery FMD, your physician will likely prescribe medications.

• #5 Fibromuscular Dysplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493204/

  Major therapeutic goals of fibromuscular dysplasia (FMD) include controlling risk factors, controlling blood pressure, and preventing ischemic events. […] If the disorder presents with a transient ischemic attack (TIA), then one may attempt treatment with thrombolytics or percutaneous thrombectomy. One should always consider a diagnosis of FMD if the individual is young and develops a stroke. IF FMD is diagnosed on routine imaging without symptoms, then antiplatelet agents should be started. […] Controlling hypertension is the cornerstone in the treatment of renal FMD. Angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) is the drug of choice, given activation of the renin-angiotensin-aldosterone system in renal FMD. […] Anti-platelet therapy with aspirin is reasonable for all FMD patients with an ischemic insult like stroke or renal infarct. Anticoagulation is reserved for patients with renal or extracranial dissection.

• #6 Fibromuscular Dysplasia: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17001-fibromuscular-dysplasia-fmd

  Theres no cure for FMD. Treatment focuses on relieving symptoms and preventing complications. […] Treatment for FMD varies, depending on the arteries affected, severity and symptoms. Options may include: Antiplatelet drugs or anticoagulant drugs to thin your blood, which can prevent clots and stroke. Medications for high blood pressure, such as ACE inhibitors and angiotensin receptor blockers. Treatments for headaches and pain, such as botulinum toxin injections (Botox) or aspirin. Angioplasty, which uses a tiny balloon inserted through a catheter to open an artery. Surgery to repair aneurysms or create new paths for blood to travel. […] If you have signs of FMD, talk to a healthcare provider. They can offer diagnostic tests, as well as treatments to reduce symptoms and prevent complications.

• #7 Fibromuscular Dysplasia Treatment & Therapies | FMD Treatment & Management Program in Northeast Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/fibromuscular-dysplasia-program/fibromuscular-dysplasia-treatment-and-management

  The best course of treatment for fibromuscular dysplasia (FMD) is different for each patient. […] For many patients, the FMD treatment plan is focused on medical therapy (for blood pressure control and to prevent blood clots) managing symptoms and monitoring the disease. […] Some patients with FMD will need a vascular procedure, such as a kidney artery angioplasty or treatment of an aneurysm. […] Medical therapies for patients with FMD are important for management of FMD-related symptoms, control of blood pressure, and to prevent complications. […] In order to prevent blood clot formation, your physician may prescribe an antiplatelet medications, such as aspirin or clopidogrel. […] For patients experiencing high blood pressure due to renal artery FMD, your physician will likely prescribe medications.

• #8 Fibromuscular dysplasia // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/fibromuscular-dysplasia

  Treatments are available to control symptoms and help prevent complications, such as stroke. But there is no cure for fibromuscular dysplasia. […] Treatment for fibromuscular dysplasia depends on: The area of the narrowed artery. Your symptoms. Any other health conditions you have, such as high blood pressure. […] Some people only need regular health checkups. Other treatments may include medicines and procedures to open or repair an artery. If your symptoms change or if you have an aneurysm, you may need repeated imaging tests to check your arteries. […] If you have fibromuscular dysplasia and high blood pressure, medicines are usually given to control blood pressure. […] Types of medicines that may be used include: Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), enalapril (Vasotec) or lisinopril (Zestril), help relax blood vessels. Angiotensin 2 receptor blockers. These medicines also help relax blood vessels. Examples include candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar) and valsartan (Diovan). Diuretics. Sometimes called water pills, these medicines help remove excess fluid from the body. A diuretic is sometimes used with other blood pressure medicines. Hydrochlorothiazide (Microzide) is an example of this type of medicine. Calcium channel blockers, such as amlodipine (Norvasc), nifedipine (Procardia XL) and others, help relax blood vessels. Beta blockers, such as metoprolol (Lopressor, Toprol XL), atenolol (Tenormin) and others, slow the heartbeat.

• #9 Fibromuscular Dysplasia: Symptoms, Treatment, and Life Expectancy

  https://www.healthline.com/health/fibromuscular-dysplasia

  Theres no cure for FMD, but you can manage it. Treatments can help you to manage your symptoms and prevent complications of the disease. […] Many people find some degree of relief from blood pressure medications, including: angiotensin II receptor blockers: candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan) […] You may also need to take blood thinners, such as aspirin, to prevent blood clots. These make it easier for blood to pass through narrowed arteries. […] Additional treatment options include: […] A thin tube called a catheter with a balloon at one end is threaded into the narrowed artery. Then, the balloon is inflated to keep the artery open. […] If you have a blockage in your artery, or your artery is extremely narrow, you may need surgery to fix it. Your surgeon will either remove the blocked part of your artery or reroute blood flow around it.

• #10 Treatment of Fibromuscular Dysplasia of the Brachial Artery with Amlodipine – SHM Abstracts | Society of Hospital Medicine

  https://shmabstracts.org/abstract/treatment-of-fibromuscular-dysplasia-of-the-brachial-artery-with-amlodipine/

  This is a 65yearold caucasian woman admitted after developing purple discoloration, pain, swelling, and loss of sensation of her right thumb. […] The patient was transferred to the Medicine service and started on amlodipine. Dramatic improvement in perfusion of the right hand was seen, with near resolution of the discoloration, paresthesias, pain, and coolness. […] We describe the fifth reported case of this clinical entity, and the first successful treatment of ischemia due to this entity with amlodipine.

• #11 Fibromuscular Dysplasia Treatments | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/neurosciences/comprehensive-stroke-centers/fibromuscular-dysplasia/treatments

  There is no cure for fibromuscular dysplasia (FMD). Northwestern Medicine specialists offer options to help you manage your symptoms, including risk reduction and treatment to improve blood flow through the affected arteries, so you can maintain your quality of life. Treatments may include: […] Various medications can help you manage your symptoms or prevent serious complications, including: […] Medications that lower your blood pressure and reduce the force of your contractions can help minimize the growth of an aneurysm. […] Blood thinners, including low-dose aspirin, may be used to help prevent a stroke. […] Migraine medications or Botox injections to the scalp have proven effective in treating headaches. […] A long, thin, flexible tube (catheter) with a balloon tip is inserted into an artery that contains an aneurysm (bulge) or is at risk of dissection (tearing). The balloon is inflated and a tiny coil or stent is placed in the artery permanently to protect the integrity of the artery wall.

• #12 Fibromuscular dysplasia (FMD) | Kidney Care UK

  https://kidneycareuk.org/kidney-disease-information/kidney-conditions/fibromuscular-dysplasia-fmd/

  There is currently no direct cure for FMD, so treatment focuses on reducing blood pressure with medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). […] Aspirin may be prescribed to thin the blood to help reduce the risk of stroke. […] To improve the flow of blood through a narrowed artery, a procedure called an angioplasty might be performed. This takes place under a local anaesthetic and involves a thin tube being inserted into the affected artery and a small balloon being inflated within the artery itself. Sometimes a metal stent will be inserted to keep the artery open and improve blood flow. […] FMD is more common and more serious in people who smoke so help to stop smoking will be offered if it is needed.

• #13 Fibromuscular Dysplasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/1161248-treatment

  Physical and occupational therapy and speech therapy may be important aspects of care in fibromuscular dysplasia (FMD) should neurologic deficits exist. Neurorehabilitation generally helps to recover function if any residual neurologic deficits are present. […] Partly because of the unknown etiology of fibromuscular dysplasia (FMD), no curative therapy exists. Fortunately, FMD is often benign when asymptomatic, and medical treatment is not indicated. Patients presenting with hypertension should be evaluated by a nephrologist and possibly considered for vascular intervention. […] If only FMD is identified on angiography, medical treatment usually incorporates antiplatelet agents, similar to the treatment of atherosclerotic disease. Often, daily aspirin is considered first-line therapy, and another antiplatelet agent is substituted or added if another ischemic event occurs (such as clopidogrel or combination acetylsalicylic acid and extended-release dipyridamole).

• #13 Fibromuscular Dysplasia Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/1161248-treatment

  Surgical vascular reconstruction of renal fibromuscular dysplasia (FMD) has met with good success. […] Although medical management of stroke prophylaxis in FMD is quite similar to the management of atherosclerotic disease, the lesions in FMD are not amenable to endarterectomy. Thus, surgical management is used as a last resort in cases where stenosis is critical and global cerebral hypoperfusion is an issue or for ischemic events refractory to medical management. […] Because of the emergence of endoluminal angioplasty and stenting for cerebrovascular disease, interventional radiologic management of FMD lesions may be suitable for some patients, especially those who are not good surgical candidates.

• #14 Treatment – Fibromuscular Dysplasia

  https://www.fmd-be.be/treatment/

  To date there is no cure for FMD. However, FMD can be adequately managed with the objective of alleviating symptoms and preventing complications. […] Medications such as antihypertensive drugs may be prescribed in the case of renal artery FMD causing hypertension. Blood thinners, in the form of low dose aspirin may also be recommended, particularly in the case of multifocal FMD, or FMD of the cerebrovascular (head and neck) arteries. […] Many FMD patients suffer from headaches, often migraines (which can be experienced as throbbing or pulsating) that may be treated by painkillers as needed, or an anti-migraine treatment. Certain antihypertensives such as beta blockers may prevent headache. Vasoconstrictors such as Ergotamine and Triptans are in principle contraindicated in patients with FMD.

• #15 Renal Artery Fibromuscular Dysplasia Update – Endovascular Today

  https://evtoday.com/articles/2012-feb/renal-artery-fibromuscular-dysplasia-update

  Most instances of recurrence of disease after PTA are related to inadequate angioplasty the first time. Usually, a second PTA results in cure or improvement in blood pressure. It is important to measure pressure gradients before and after angioplasty to help assess whether all of the arterial webs have been disrupted and the pressure gradient has been obliterated. […] All patients with renal artery FMD are empirically prescribed low-dose daily aspirin therapy (81 mg).

• #15 Renal Artery Fibromuscular Dysplasia Update – Endovascular Today

  https://evtoday.com/articles/2012-feb/renal-artery-fibromuscular-dysplasia-update

  Hypertension attributed to renal artery FMD is often successfully treated with balloon angioplasty alone. There is no need for stent implantation under most circumstances. Stenting of the mid-distal arterial segments often affected by FMD may prohibit potential target sites for surgical revascularization should that option become necessary. We advocate two indications for stenting in renal artery FMD: (1) if the pressure gradient cannot be obliterated with angioplasty alone; and (2) when a renal artery dissection arises spontaneously or is created iatrogenically during intervention. The primary role for surgical revascularization is to treat aneurysms in patients in whom endovascular therapy is not an option or is unsuccessful. […] PTA has supplanted surgical revascularization as the preferred treatment of renal artery FMD. Angioplasty has several advantages over open surgical revascularization: it can be performed with a high degree of technical and clinical success with minimal complications, it is less invasive, has a markedly shorter recovery time, is less expensive, and the procedure is now frequently performed electively on an outpatient basis. In most patients, PTA results in blood pressure reduction and can be used to treat lesions involving the main or branch arterial segments.

• #15 Renal Artery Fibromuscular Dysplasia Update – Endovascular Today

  https://evtoday.com/articles/2012-feb/renal-artery-fibromuscular-dysplasia-update

  Renal artery FMD occurs in about 70% of patients with FMD and is often bilateral. The most common manifestation of renal artery FMD is hypertension caused by renal artery stenosis activating the renin angiotensin aldosterone axis. It has been suggested that renal artery aneurysms occur in approximately 5% to 10% of patients with FMD. […] The primary goal in treating patients with renal artery FMD is the control of blood pressure to prevent the sequelae of long-standing, poorly controlled hypertension. In patients in whom high blood pressure is newly diagnosed and secondary to renal artery FMD, the initial treatment may be percutaneous balloon angioplasty (PTA). The chance of curing patients so that they no longer need to take antihypertensive medications is highest when the patient is young and the duration of hypertension is short.

• #16 Fibromuscular Dysplasia – MD Searchlight

  https://mdsearchlight.com/health/fibromuscular-dysplasia/

  Fibromuscular dysplasia (FMD) is a medical condition that often requires different treatment strategies. These may include controlling risk factors, managing blood pressure, and preventing things called ischemic events that occur when blood flow to a certain part of your body is reduced. […] When FMD shows up with a warning sign of a possible stroke, known as a transient ischemic attack (TIA), doctors might try to treat it with clot-dissolving medicine or a procedure called percutaneous thrombectomy. This procedure removes the clot from your blood vessels. FMD should be considered if a young person has a stroke. If FMD is spotted on medical images before the person has any symptoms, then medications that prevent blood clots may be given. […] Occasionally, FMD can cause a tear in the walls of the blood vessels, known as artery dissection. This is usually managed with blood-thinning medications for 3-6 months once any bleeding issues have been ruled out.

• #16 Fibromuscular Dysplasia – MD Searchlight

  https://mdsearchlight.com/health/fibromuscular-dysplasia/

  Controlling high blood pressure is key in the treatment of FMD related to the kidneys. Certain medications like angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are often used because of their ability to affect the renin-angiotensin-aldosterone system, a hormone system that plays a big role in regulating blood pressure and the balance of fluids in your body. […] Quitting smoking can really help because FMD often gets worse more quickly in smokers compared to non-smokers. […] Sometimes, less invasive treatments might not be enough to manage FMD. In these cases, procedures to restore blood flow to the affected organ, called revascularization, can be needed. […] In most cases, an approach called percutaneous transluminal angioplasty (PTA) is the first choice for revascularization. This non-surgical procedure is designed to open up blocked blood vessels. It has a high success rate and can cure high blood pressure in 60% to 80% of patients. […] While surgical revascularization is an option, its usually only recommended for patients with smaller renal arteries or those who didnt respond to PTA. Regardless of the type of treatment used, doctors will recommend regular follow-up visits with ultrasound tests to monitor the patients condition.

• #17 Fibromuscular Dysplasia and Stroke

  https://practicalneurology.com/articles/2020-jan/fibromuscular-dysplasia-and-stroke

  Nonetheless, antiplatelet therapy may be preferred because of safety and convenience, unless there is clear intraluminal thrombus or recurrent thromboembolic events despite antiplatelet therapy. […] There are no randomized trials of endovascular treatment of CeAD in the setting of FMD. […] Those with FMD at risk for incident or recurrent CeAD are advised to avoid activities associated with extreme hyperextension or lateral rotation of the neck, especially chiropractic cervical spinal manipulation. […] Management of acute stroke in patients with FMD should follow standard stroke guidelines. […] People with FMD and history of stroke should be on antiplatelet medication for secondary prevention, unless there is a competing stroke mechanism warranting anticoagulation such as paroxysmal atrial fibrillation or a hypercoagulable state. […] Asymptomatic FMD when discovered incidentally has a favorable natural history. […] The incidence of stroke in FMD is primarily associated with CeAD and can be managed conservatively with antiplatelet therapy and avoidance of high-risk cervical exertion.

• #17 Fibromuscular Dysplasia and Stroke

  https://practicalneurology.com/articles/2020-jan/fibromuscular-dysplasia-and-stroke

  Management of cerebrocervical FMD is largely dependent on the presenting symptoms and any associated neurologic complications such as CeAD, migraine, or aneurysm. […] Headache management in individuals with or without FMD is similar and largely driven by an accurate characterization of the headache subtype. […] However, an important consideration in patients with FMD regards use of vasoactive abortive medications, such as ergots and triptans, which may introduce additional risk in patients already at risk for stroke or dissection. […] Alternative abortive therapies for acute migraine in the setting of FMD may include antidopaminergic class (eg, prochlorperazine, metoclopramide), or a brief steroid taper. […] The CADISS study compared 3 to 6 months of antiplatelet therapy with 3 to 6 months of anticoagulation with warfarin and showed no difference in stroke recurrence after the initial CeAD event.

• #18 Does treatment with olmesartan improve arterial stenoses due to fibromuscular dysplasia? | Hypertension Research

  https://www.nature.com/articles/hr2009126

  Fibromuscular dysplasia (FMD) represents a group of non-atherosclerotic, non-inflammatory arterial diseases that most commonly involve renal and carotid arteries. […] No data are available in literature about the remission of arterial stenoses during treatment of FMD. As suggested by the Fibromuscular Dysplasia Society of America, there are no treatment protocols for FMD, and management depends on which arteries are affected and on symptoms. When FMD produces minimal stenotic lesions, it may be managed conservatively by antiplatelet or anticoagulant therapy as prophylaxis against complications. […] A case of FMD diagnosed in a 52-year-old hypertensive woman involving internal carotid arteries, celiac tripod and the mesenteric superior artery was treated with acetylsalicylic acid (100mg daily), and for arterial hypertension with olmesartan (20mg daily) and hydrochlorothiazide 12.5mg daily.

• #18 Does treatment with olmesartan improve arterial stenoses due to fibromuscular dysplasia? | Hypertension Research

  https://www.nature.com/articles/hr2009126

  The bilateral carotid bruits found at the initial physical examination disappeared at follow-up; this finding led to a repeat neck ultrasound of extracranial vessels and to subsequent angiographic imaging. […] Computed angiotomography of the arteries involved by FMD also showed that the string-of-beads pattern, the severe stenosis of the celiac tripod and the moderate stenosis of the mesenteric superior artery previously observed were no longer evident, and the arterial wall became almost rectilinear, particularly in the right internal carotid artery. […] Although it is arduous to accept that AT1-blockers may have a pleyotropic effect that modifies the natural history of FMD, it is difficult as well to not attribute the modifications of arteries observed on imaging to medical treatment. Our results are not a completely new notation, as it has recently been shown that AT1-blockers are effective both in remodeling and in delaying the re-stenosis of renal arteries after angioplasty in subjects with FMD. […] This suggests a potential efficacy of AT1-blockers in modifying the natural history of non-atherosclerotic arterial diseases such as FMD.

• #19 Treatment of fibromuscular dysplasia of the renal arteries – UpToDate

  https://www.uptodate.com/contents/treatment-of-fibromuscular-dysplasia-of-the-renal-arteries/print

  Treatment options for patients with renal artery FMD include medical therapy alone, or revascularization by either percutaneous transluminal angioplasty (PTA) or surgery. […] However, independent of angioplasty, hypertension should be treated. […] The treatment of renal artery FMD will be reviewed here.

• #20 Fibromuscular Dysplasia Treatment & Therapies | FMD Treatment & Management Program in Northeast Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/fibromuscular-dysplasia-program/fibromuscular-dysplasia-treatment-and-management

  Lifestyle changes may also be recommended to manage high blood pressure, such as reducing the amount of sodium (salt) in your diet, maintaining a healthy body weight, and aerobic exercise. […] Depending on the location of FMD and the type and severity of FMD symptoms, certain vascular procedures may be recommended by your physician. […] The most common vascular procedure recommended for patients with FMD is balloon angioplasty of the renal arteries for treating hypertension caused by narrowing of the kidney arteries. […] An angioplasty is used to widen narrowed arteries and may be recommend for patients that have new or recent onset of high blood pressure or uncontrolled high blood pressure due to renal FMD. […] In addition to treatment of artery narrowing due to FMD, some patients with FMD may have aneurysms that require treatment to prevent complications from aneurysm rupture.

• #21 Fibromuscular Dysplasia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493204/

  Revascularization is indicated in young adults with resistant hypertension, to prevent ischemic nephropathy in severe stenosis with the goal of curing hypertension. […] Percutaneous transluminal angioplasty (PTA) is the first-line modality for revascularization, with cure rates reaching 60% to 80% and technical success rate up to 100%. […] There are no randomized control trials comparing PTA with surgical revascularization. PTA is the preferred choice over surgery because it is less invasive, lower cost, and has fewer complications.

• #22 Fibromuscular dysplasia // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/fibromuscular-dysplasia

  Treatments may be needed to repair a narrowed or damaged artery. These may include: Percutaneous transluminal angioplasty (PTA). This treatment uses a thin flexible tube called a catheter and a tiny balloon to widen a narrowed artery. It helps improve blood flow to the affected area. A metal mesh tube called a stent may be placed inside the weakened part of the artery to keep it open. Surgery to repair or replace the damaged artery. Also called surgical revascularization, this treatment is rarely recommended. But it may be suggested if you have severe narrowing of the arteries and angioplasty isn’t an option. The type of surgery done depends on the location of the narrowed artery and the amount of damage.

• #23 Fibromuscular dysplasia | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/fibromuscular-dysplasia-1?lang=us

  Fibromuscular dysplasia responds well to angioplasty, with high long-term patency rates. A stent is generally not required. […] Asymptomatic cases are only observed but if symptomatic then fibromuscular dysplasia responds well to angioplasty, with high long-term patency rates. A stent is generally not required.

• #24 Treatment options in fibromuscular dysplasia of the renal artery: when percutaneous transluminal angioplasty is at high risk? | Hypertension Research

  https://www.nature.com/articles/hr2012193

  A 26-year-old woman was seen in the emergency room for recent onset hypertension. […] The primary goal in the treatment of patients with renal artery FMD is hypertension control to prevent target organ damage. In patients with non-atherosclerotic renal artery disease associated with severe hypertension, endovascular or open renal revascularization is superior to medical management alone. However, PTA, with or without stenting, and surgical intervention are offered only in case of poor blood pressure control, intolerable side effects of the medications, reduction of renal size or reduction of renal function. […] PTA is the recommended first-step therapy, as it is very effective with no need for stent implantation in most circumstances. Stenting is considered for treating dissection and if the gradient cannot be obliterated with angioplasty alone.

• #24 Treatment options in fibromuscular dysplasia of the renal artery: when percutaneous transluminal angioplasty is at high risk? | Hypertension Research

  https://www.nature.com/articles/hr2012193

  According to current guidelines, surgical revascularization should be performed to treat aneurysms in patients in whom endovascular therapy is not an option or after PTA failure, despite the observations that it controls hypertension better than endovascular therapy, and it provides the most durable long-term results. […] Furthermore, vascular surgical reconstruction is indicated for patients with FMD renal artery stenosis exhibiting complex disease that extends into the segmental arteries and those having macro aneurysms. […] As there is no consideration of the site of stenosis in the current guidelines, we suggest that the site of stenosis is included among the vascular characteristics that guide treatment choices for FMD.

• #25 Endovascular management of an unsual case of spontaneous Retroperitoneal Haemorrhage due to Fibromuscular Dysplasia | CVIR Endovascular | Full Text

  https://cvirendovasc.springeropen.com/articles/10.1186/s42155-020-00157-8

  Cutting-balloon angioplasty is usually reserved to treat lesions resistant to conventional angioplasty. […] Other techniques like renal artery denervation therapy or drug coated-balloon angioplasty has been recently described obtaining good outcomes; however, more studies are needed before generalizing these new therapy options in the context of FMD. […] Finally, recommendations such as quitting smoking, keeping an adequate weight, avoiding extreme exercise or contact sports, are also very common and highly important. […] This report highlights that endovascular procedures are safe, feasible and technically successful in treating both conditions and should be considered as a first line treatment.

• #26 Sex and Gender Differences in Fibromuscular Dysplasia | USC Journal

  https://www.uscjournal.com/articles/sex-and-gender-differences-fibromuscular-dysplasia?language_content_entity=en

  Dissections and aneurysms are common complications of FMD, occurring in more than 40% of patients with FMD. […] The general consensus is that the treatment of dissections and aneurysms in the setting of FMD should be no different than that of the general population with these vascular pathologies. […] Last, adjunct medical therapy with symptomatic and preventative agents is often used to address the concomitant symptoms of migraine and other headache types in FMD patients.

• #27 Fibromuscular Dysplasia Diagnosis & Treatment Options

  https://www.dukehealth.org/treatments/brain-arterial-diseases/fibromuscular-dysplasia

  Duke brain, kidney, and vascular specialists diagnose and treat fibromuscular dysplasia (FMD). This abnormal cell growth causes narrowing, bulging, or tearing in certain arteries, most commonly those leading to the brain and kidneys. We help you manage complications such as high blood pressure and minimize the risk of kidney failure, aneurysm rupture, and stroke. […] Your treatment plan will depend on your health status and the location and size of the narrowed or bulging artery. […] Neurologists may prescribe drugs to lower cholesterol, lower blood pressure, prevent blood clots, treat headaches or other symptoms, and reduce your risk for serious complications. […] A surgeon makes a small incision, inserts a catheter, and threads it through your circulatory system to the damaged artery. Next, a small flexible balloon is inflated, pushing against the artery walls and opening the blockage. In some cases, surgeons may recommend placing a small stent to help keep the vessel open. […] In rare cases, you may need surgery to repair or replace a damaged artery. We use the most advanced and least-invasive techniques possible to ensure you receive the most effective treatment.

• #28 Fibromuscular Dysplasia | Frankel Cardiovascular Center | Michigan Medicine

  https://www.umcvc.org/conditions-treatments/fibromuscular-dysplasia

  While there is no cure for fibromuscular dysplasia, patients with carotid or vertebral artery involvement are often prescribed aspirin to reduce the risk of stroke. Blood pressure medication helps control high blood pressure in patients with renal artery FMD. […] Endovascular or surgical repair of the affected artery may also be recommended to improve blood flow. […] Balloon angioplasty is often recommended for patients with renal artery FMD who have uncontrollable blood pressure, cannot tolerate medication or have declining kidney function. During this procedure, which widens the affected artery and improves blood flow, a balloon is inserted through a catheter into a large artery in the groin and advanced to the affected artery. The balloon is inflated to open the impaired artery. […] In some cases, angioplasty may also be performed in patients with carotid or vertebral artery FMD who have severe neurological symptoms. For symptomatic patients with carotid or vertebral artery FMD who have suffered a dissection, angioplasty with placement of a stent may be performed. […] For patients who are not candidates for angioplasty, surgery may be necessary to repair the narrowed portion of the artery. In some cases, the renal artery may be replaced or bypassed with a vein from the leg.

• #29 An Unusual Case of Fibromuscular Dysplasia with Bilateral Renal Macroaneurysms: Three-year Outcome After Endovascular Treatment

  https://opencardiovascularmedicinejournal.com/VOLUME/7/PAGE/50/FULLTEXT/

  The various percutaneous approaches, similar to those developed for intracranial aneurysm treatment, are based on different embolization techniques or stent grafts, depending on malformations anatomy. […] In our patient, both renal arteries and aneurysms had different anatomy. […] Hence, this second aneurysm was treated by using two Multilayer Cardiatidis flow diverter stents obtaining a complete exclusion of the aneurysm from renal perfusion and midbranch artery flow preservation. […] The association between FMD, RAAs and hypertension is an extremely rare condition whose optimal treatment strategy is uncertain. […] For this reason two different endovascular approaches have been used and both of them resulted effective after a 3-years follow-up.

• #30 Fibromuscular Dysplasia Treatment & Therapies | FMD Treatment & Management Program in Northeast Ohio | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/fibromuscular-dysplasia-program/fibromuscular-dysplasia-treatment-and-management

  You should talk to your FMD doctor about potential modifications to your lifestyle in order the manage FMD. […] These may include: Moderate aerobic exercise, such as walking or jogging, cycling, or aerobic dance; Eating a well-balanced diet, rich in fruits and vegetables for overall cardiovascular health; Low sodium diet for FMD patient with high blood pressure; Quit smoking; recent studies have shown that patients with FMD who smoke have more complications. […] Depending on the specifics of your case, your FMD provider may recommend against certain activities that could potentially increase the risk of an artery dissection.

• #31 Fibromuscular dysplasia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fibromuscular-dysplasia/diagnosis-treatment/drc-20352150

  Treatment for fibromuscular dysplasia depends on: […] Some people only need regular health checkups. Other treatments may include medicines and procedures to open or repair an artery. If your symptoms change or if you have an aneurysm, you may need repeated imaging tests to check your arteries. […] If you have fibromuscular dysplasia and high blood pressure, medicines are usually given to control blood pressure. […] Types of medicines that may be used include: […] Treatments may be needed to repair a narrowed or damaged artery. These may include:

• #32 Fibromuscular Dysplasia | Mount Sinai – New York

  https://www.mountsinai.org/care/surgery/services/vascular-surgery/conditions/arterial-conditions/fibromuscular-dysplasia

  A rare vascular disease, fibromuscular dysplasia (FMD) can affect any artery in your body. […] While there is no cure for FMD, we can treat it effectively. […] 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 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.

• #33

  https://link.springer.com/article/10.1007/s11936-016-0460-z

  Fibromuscular dysplasia (FMD) is an arteriopathy of unknown etiology which has traditionally been associated with secondary hypertension; however, it has garnered increased attention in the cardiology field in the recent years because of its potential association with spontaneous coronary artery dissection. […] For these reasons, some experts recommend panvascular imaging from head-to-pelvis upon diagnosis for screening purposes and targeted imaging surveillance after diagnosis. […] When necessary, endovascular intervention with angioplasty alone is the preferred modality, though there are still situations which require surgical intervention. […] Patients with FMD may benefit from a multispecialty team approach for optimal treatment.

• #34 Fibromuscular Dysplasia (FMD) and Arterial Dissection Clinic | Cleveland Clinic

  https://my.clevelandclinic.org/departments/heart/depts/fibromuscular-dysplasia-clinic

  Fibromuscular dysplasia can also affect the arteries to the intestines (the mesenteric arteries), the arteries to the legs or arms, the coronary arteries (arteries that supply blood to the heart), and arteries in other parts of the body, although this is less common. Many times, arteries in more than one location are affected by FMD. […] FMD Clinic specialists diagnose and treat Fibromuscular dysplasia (FMD). […] In addition, our clinicians specialize in the treatment of patients with Spontaneous Coronary Dissection (SCAD) and cervical (carotid or vertebral) artery dissection. […] Care is provided by vascular medicine specialists who collaborate with a multidisciplinary team, including interventional cardiologists, vascular surgeons, nephrologists, neurologists, radiologists and geneticists. Your healthcare team will work with you to develop a treatment plan tailored to your needs and condition. […] Most patients follow-up in 6 months to 1 year or as needed. In some cases, patients may be referred for additional vascular procedures, such as angioplasty or vascular surgery or treatment of an aneurysm.

• #35 Fibromuscular Dysplasia | The University of Kansas Health System

  https://www.kansashealthsystem.com/care/conditions/fibromuscular-dysplasia

  The University of Kansas Health Systems fibromuscular dysplasia care program involves collaboration among many specialties, including vascular medicine, cardiology, nephrology, neurology, vascular surgery and genetics. Our health system offers advanced diagnosis, treatment and long-term management of FMD. […] The specific treatment your care team recommends for fibromuscular dysplasia depends on a number of different factors: […] Treatment options for fibromuscular dysplasia include oral medication, angioplasty or surgical intervention. If your symptoms are not affecting your quality of life, your doctor may recommend watchful waiting rather than treatment. […] The doctors at The University of Kansas Health System who care for people with FMD are leaders in the prevention and treatment of vascular disease. Our doctors work together under one roof in an environment offering advanced facilities and diagnostics.

• #36 UVA Health a Leader in Treating Fibromuscular Dysplasia

  https://uvaphysicianresource.com/fibromuscular-dysplasia/

  Fibromuscular dysplasia (FMD) is a serious condition that is often underdiagnosed and complex in management. UVA Health is one of only 15 U.S. healthcare centers with the requisite knowledge, skills, and infrastructure to treat FMD effectively. […] This collaborative team provides patients with a wide range of treatment options, including: […] Medications, such as antiplatelets and anticoagulants for patients at increased risk of stroke or heart attack […] Hypertension and migraine drugs […] Endovascular or open surgery procedures when required. […] „FMD isn’t managed the same way that common cholesterol or plaque-related coronary or vascular conditions are,” Sharma adds. „We look at the entire vascular system to determine the best course of treatment based on the size and location of the aneurysm or dissection as well as the problems they are causing.”

• #37 UVA Health a Leader in Treating Fibromuscular Dysplasia

  https://www.uvaphysicianresource.com/fibromuscular-dysplasia/

  Fibromuscular dysplasia (FMD) is a serious condition that is often underdiagnosed and complex in management. UVA Health is one of only 15 U.S. healthcare centers with the requisite knowledge, skills, and infrastructure to treat FMD effectively. […] This collaborative team provides patients with a wide range of treatment options, including: […] Medications, such as antiplatelets and anticoagulants for patients at increased risk of stroke or heart attack […] Hypertension and migraine drugs […] Endovascular or open surgery procedures when required. […] „FMD isn’t managed the same way that common cholesterol or plaque-related coronary or vascular conditions are,” Sharma adds. „We look at the entire vascular system to determine the best course of treatment based on the size and location of the aneurysm or dissection as well as the problems they are causing.” […] She notes that their work with the iSCAD registry is helping the team learn more about the disease process and identify future therapies.

• #38 FAQs about Fibromuscular Dysplasia

  https://www.massgeneral.org/vascular-center/treatments-and-services/faq-fibromuscular-dysplasia

  Genetic counseling: Because FMD appears to run in families, women of childbearing age may receive counseling for the genetic basis of the condition. There is not yet a genetic test for FMD. […] Psychosocial treatment: FMD often affects young, otherwise healthy women, and coping with it can be difficult. Psychologists or other mental health professionals can offer counseling to help patients deal with the stress and anxiety that may accompany having FMD […] Obstetrics/gynecological care: Specialists in obstetrics and gynecology can advise patients with FMD about the use of oral contraceptives, estrogen therapy and other hormone-based medications, which can affect blood flow in the arteries.

• #39 Fibromuscular Dysplasia Program

  https://www.massgeneral.org/vascular-center/treatments-and-services/fibromuscular-dysplasia-program

  We work closely with the Benson-Henry Institute for Mind Body Medicine, psychologists and other mental health professionals who offer counseling to help patients deal with the stress and anxiety that may accompany the condition. […] Specialists in obstetrics and gynecology can advise patients with FMD about the use of oral contraceptives, estrogen therapy and other hormone-based medications, which can affect blood flow in the arteries. […] Because FMD appears to run in families, women of childbearing age may receive counseling about the genetic basis of the condition.

• #40 Fibromuscular Dysplasia (FMD) – Rare Awareness Rare Education

  https://rareportal.org.au/rare-disease/fibromuscular-dysplasia-fmd/

  Whilst there is no overall curative treatment, there are available therapies for managing Fibromuscular Dysplasia (FMD). The management strategies may depend on an individuals diagnosis and specific symptoms and complications. Therapies may involve antiplatelet therapy (such as use of aspirin), medication to treat hypertension and migraines, and specific treatment of aneurysm and arterial dissection. […] Close monitoring and intensive follow-up may be required during pregnancy. There may also be some lifestyle considerations that can assist in the management of FMD. […] It is best to speak with your medical team to learn more about suitable management strategies for FMD. More information can also be found in this document describing the first international consensus on the diagnosis and management of fibromuscular dysplasia.

• #41 Fibromuscular Dysplasia Treatment – The Doctor’s Channel

  https://www.thedoctorschannel.com/view/fibromuscular-dysplasia-treatment-2/

  Treatment depends on vascular beds involved and patients clinical symptoms. Summary: Renal FMD is best treated by balloon angioplasty. Stents are not recommended for renal or carotid FMD and those patients with carotid pathology must be screened for intracranial aneurysms. […] For more information, please visit www.fmdsa.org.

• #42

  https://link.springer.com/article/10.1007/s11936-005-0017-z

  The most common clinical manifestations of fibromuscular dysplasia (FMD) are hypertension due to renal artery involvement and transient ischemic attack or stroke due to carotid or vertebral artery involvement. Patients with renal artery FMD and hypertension should undergo primary angioplasty with the goal of curing the hypertension. If the blood pressure fails to normalize following angioplasty, the physician should institute antihypertensive medications according to the recommendations of the Joint National Committee on the Prevention, Detection, and Treatment of High Blood Pressure VII. […] In patients with cerebrovascular FMD, antiplatelet agents represent the cornerstone of therapy. Percutaneous angioplasty has emerged as the preferred treatment for symptomatic cerebrovascular FMD. […] This retrospective study represents one of the largest contemporary series of patients with hypertension and renal artery fibromuscular disease. Technical success and clinical outcomes were excellent using balloon angioplasty of the renal artery as primary therapy.

• #43 Fibromuscular dysplasia – Wikipedia

  https://en.wikipedia.org/wiki/Fibromuscular_dysplasia

  There is no known cure for FMD. However, treatment focuses on relieving associated symptoms. Medical management is the most common form of treatment. The best approach to medically managing these patients is constantly being re-evaluated as more information is learned about the disease. […] Blood pressure control is the primary concern when treating patients with renal FMD, as the ideal blood pressure target in patients with FMD is unknown. In cases of renal artery stenosis and indications for intervention, percutaneous balloon angioplasty may be recommended. Many studies have assessed the success rate of percutaneous transluminal angioplasty (PTA) in these cases, and have found relief of hypertensive symptoms. […] Patients with carotid or vertebral FMD are medically managed to reduce the risk of a stroke. Aspirin 81 mg is typically prescribed for patients with carotid FMD. Antiplatelets and anticoagulants may be used to reduce the risk of blood clot formation. If a TIA or stroke occur, percutaneous angioplasty and antiplatelet therapy may be necessary.

• #44

  https://www.fmdsa.org/

  What kind of treatment is there for FMD? […] Mount Sinai study could lead to new treatments for FMD […] Mount Sinai researchers identify key gene driver of Fibromuscular Dysplasia offering new hope for treatment […] The Fibromuscular Dysplasia Society of America (FMDSA) is a not-for-profit patient advocacy organization working towards better diagnosis and treatment of Fibromuscular Dysplasia (FMD). […] The Fibromuscular Dysplasia Society of America is a public health charity working towards better diagnosis and treatment of Fibromuscular Dysplasia (FMD). We do this by building awareness of FMD, funding research activities, providing patient support, and educating patients and the healthcare community. […] In 2007, the Fibromuscular Dysplasia Society of America (FMDSA) decided to begin a registry to better understand the disease and its treatment. The goals of this registry are to identify patient characteristics associated with FMD, potential markers of the disease, and commonly used imaging and treatment modalities, among others. […] There is no known cause or cure for the disease and there are no set protocols to treat the disease.

• #45 UVA Health a Leader in Treating Fibromuscular Dysplasia

  https://uvaphysicianresource.com/fibromuscular-dysplasia/

  She notes that their work with the iSCAD registry is helping the team learn more about the disease process and identify future therapies. […] „The collaborative nature of UVA Health, coupled with our focus on basic and translational science, aligns perfectly with the collaborative nature of the FMD and iSCAD registries,” Taylor says. „We’re all working together to treat patients today and find the mechanisms and therapies that will lead to future cures.”

• #46 Fibromuscular dysplasia (FMD) » The Texas Heart Institute

  https://www.texasheartmedical.org/our-specialties/fibromuscular-dysplasia-fmd-2/

  A treatment strategy for FMD may include different medications, such as medicine for blood pressure and clots, or even require vascular procedures, such as angioplasty or surgery. […] What kind of treatment is there for FMD? […] The Texas Heart Institute’s participation in the FMD Registry underscores its long-standing commitment to advancing research and improving care for those affected by FMD. By participating in the registry, The Texas Heart Institute contributes clinical information that can help inform treatment decisions and improve outcomes for FMD patients.

• #47 Bringing Awareness to an Under-Recognized Medical Conundrum – Fibromuscular dysplasia: state of the science and critical unanswered questions – Professional Heart Daily | American Heart Association

  https://professional.heart.org/en/science-news/fibromuscular-dysplasia-state-of-the-science-and-critical-unanswered-questions/Commentary

  Fibromuscular dysplasia (FMD) is a non-inflammatory, arterial disease that most often affects women less than 65 years of age. […] The clinical manifestations of FMD are most often related to the arterial bed involved and the underlying vascular pathology present. […] FMD can be associated with symptomatic or asymptomatic arterial stenoses, occlusions, dissections, and/or aneurysms, with related hypertension, transient ischemic attacks, stroke, cardiac arrhythmias, myocardial ischemia, claudication, mesenteric ischemia, embolic phenomena, and/or intracranial, retroperitoneal, or intraperitoneal hemorrhages. […] For a stenosis related to FMD, a stent is reserved to treat a complication of the PTA procedure, such as an obstructing dissection flap or rupture. […] On occasion, a bare metal, multilayer, or covered stent may be used primarily to treat an obstructing, spontaneous, and symptomatic dissection or aneurysm. […] The top 11 research priorities for FMD as suggested by Olin et al. include determining the following: feasibility of a randomized clinical trial comparing optimal medical therapy versus endovascular therapy for the treatment of hypertension in patients with renal artery FMD.

Zobacz więcej