Dissection and aneurysm in patients with fibromuscular dysplasia

Objective: Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without. Design and method: Consecutive hypertensive patients with renal artery stenosis caused by FMD underwent catheter-based angiography, followed at two Chinese referral centers in China between January 2000 and Ouctober 2023. Results: Aneurysm occurred in 71 patients (24.6%) and dissection in 13 patients (4.5%); in total, 84 patients (29.0%) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were elder at presentation (37.6 vs. 26.5 years of age, respectively; p < 0.0001) and experienced more eurological symptoms and other end-organ ischemic events than those without dissection. One-fifth of aneurysm patients (14 of 71) underwent therapeutic intervention for aneurysm repair. Conclusions: Chinese patients with renal artery FMD had a lower prevalence of dissection at the time of FMD diagnosis than Caucasians, but similar prevalence of aneurysm. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.