Fibromuscular dysplasia: causes, symptoms, diagnosis, treatment

Fibroid dysplasia involves a heterogeneous group of non-atherosclerotic non-inflammatory changes in the arteries leading to vessel stenosis, occlusion, or the formation of aneurysms.

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Causes of fibromuscular dysplasia

Fibro-muscle dysplasia usually occurs in women aged 40-60 years. The reason is unknown. However, genetic predisposition can be important, and smoking can be a risk factor. Fibromuscular dysplasia often develops in people with connective tissue pathology (for example, type IV Ehlers-Danlo syndrome, cystic necrosis of the vascular middle shell, hereditary nephritis, neurofibromatosis).

Dysplasia of the middle shell of the vessels is the most common type of pathology. It is characterized by changing areas of thick and thin fibro-muscular fibers containing collagen and located along the middle shell (middle layer dysplasia, medial dysplasia), or by extensive deposition of collagen in the outer shell (perimedial dysplasia). Fibro-muscle dysplasia can damage the renal arteries (60-75%), carotid and intracranial (25-30%), intra-abdominal (9%) or external iliac artery (5%).

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Symptoms of fibromuscular dysplasia

Fibromuscular dysplasia usually proceeds asymptomatically regardless of the localization of pathology. If the clinical symptoms unfold, the manifestations depend on the location of pathological foci:

• lameness, noise on the femoral vessels and weakened femoral pulse, when the arteries of the leg suffer;
• secondary arterial hypertension in the defeat of the renal arteries;
• transient ischemic attacks or stroke symptoms in carotid arteries;
• symptoms of an aneurysm in the defeat of intracranial arteries;
• symptoms of ischemic bowel involvement when mesenteric arteries are involved (rarely).

Diagnosis of fibromuscular dysplasia

A reliable diagnosis is established using vasography, showing the deformation of arteries that look like beads (with medial or perimedial dysplasia), or concentric or long ribbon-like narrowing of the arteries (in other forms).

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Treatment of fibromuscular dysplasia

Treatment depends on localization. It can include percutaneous intravascular angioplasty, surgical shunting, or the removal of aneurysms. It is important to stop smoking. Control of other risk factors for atherosclerosis (arterial hypertension, dyslipidemia, diabetes mellitus) helps prevent the accelerated development of arterial stenosis.