Fibromuscular Dysplasia

Fibromuscular dysplasia (FMD) is a rare condition caused by abnormal function of the cells that make up your arteries. This leads to narrowing, bulging or a beaded appearance in the arteries. It can restrict blood flow, which can lead to health complications.

FMD commonly affects the wall muscle of your renal and carotid arteries. But it can affect any artery in your body, like mesenteric arteries that bring blood to your intestines. It also includes brachial and iliac arteries that bring blood to your arms and legs. You can also have it in more than one artery at a time.

Symptoms of fibromuscular dysplasia

Fibromuscular dysplasia symptoms vary based on which arteries it affects. If you have a mild case, you might not have any symptoms.

If FMD affects the arteries that supply your kidneys, you may have symptoms like:

• High blood pressure that’s resistant to treatment with medication
• Flank pain

Symptoms of FMD in your carotid artery may include:

• Dizziness or vertigo
• Severe headache
• Neck pain
• Whooshing or ringing sound in your ears

Symptoms of FMD in your mesenteric artery include:

• Pain in your belly after eating
• Weight loss
• Fatigue

Symptoms of FMD in your arms or legs may include:

• Coldness
• Pain
• Skin discoloration
• Tingling or numbness

Fibromuscular dysplasia causes

The cause of FMD is unknown. It may be a mix of several factors. Researchers have linked some cases to:

• Genetics (some cases are inherited)
• Hormones, like estrogen (females are much more likely to have FMD)
• Environmental factors, like smoking
• Repeated injury to an artery

Risk factors

Females are most at risk for FMD. Other risk factors for fibromuscular dysplasia include:

• Being in your 40s or 50s
• Being white
• Having certain connective tissue diseases

Complications of this condition

FMD disease can lead to serious complications. Weak artery walls make you more likely to have a bulge or tear in an artery. Severe narrowing in your carotid artery can cause stroke or transient ischemic attack (TIA). Complications include:

• Aneurysm (a bulge in an artery)
• Arterial dissection (a tear in an artery)
• Stroke
• Transient ischemic attack (a brief lack of blood flow to your brain)
• Arteriovenous fistula (an abnormal link between an artery and a vein)
• Blood clots

It’s important to learn the signs and symptoms of these complications. Your provider can explain more and tell you what you should do if you notice any of these.

How doctors diagnose FMD

A healthcare provider may find signs of FMD during a routine physical exam. An example of this is a bruit, a swishing noise your healthcare provider can hear with a stethoscope on your belly (for the renal artery) or neck (for the carotid artery).

Or a provider may discover FMD while reviewing imaging test results for other reasons.

If your provider suspects the condition, they may request:

• Vascular ultrasound
• CT angiogram
• MRA (MRI angiogram)
• Catheter-based angiogram

Some people don’t get an FMD diagnosis until they have an artery dissection or aneurysm rupture. Both of these need prompt care.

Based on what your arteries look like during diagnostic tests, your provider may describe FMD as:

• Multifocal FMD: The arteries look like a string of beads, with a repeating pattern of bulging and then narrowing. It’s the most common type.
• Focal FMD: The arteries are narrowed or bulging in one area. This type is much less common.

How is FMD treated?

Researchers haven’t found a cure for FMD. Fibromuscular dysplasia treatment focuses on relieving symptoms and preventing complications. It varies depending on the affected arteries and the severity. Options may include:

• Antiplatelet medications or anticoagulants: These thin your blood, which can help prevent clots and stroke.
• Medications for high blood pressure: Examples include ACE inhibitors and ARBs.

Surgery and procedures

Your healthcare provider may tell you that you need angioplasty. For this procedure, a provider inserts a tiny balloon through a catheter. When the balloon inflates in the problem area, it widens the artery. You can usually go home the same day or the next day.

Another way to improve blood flow is with surgery that creates a new path for blood to travel. Surgery can also repair aneurysms.

A thrombectomy procedure can remove a blood clot.

When should I see my healthcare provider?

If a close relative has FMD, you may wonder if you have it, too. You can ask your provider if you should get imaging of the blood vessels that this condition commonly affects. But if you don’t have symptoms, you may not need screening for FMD. At this time, there isn’t a genetic test that can tell you if you have the condition.

If you have symptoms of fibromuscular dysplasia, schedule a physical exam with your primary care provider.

What type of follow-up care is recommended?

Once you have a fibromuscular dysplasia diagnosis, you’ll need to have appointments at least once a year to check on your arteries. It’s also important to make sure your treatment is working.

Checkups may include imaging. Because FMD can affect arteries in more than one place, you should have imaging from your brain to your pelvis at least once.

You should be aware of symptoms that need immediate medical care. This varies, depending on the affected arteries. But it may include:

• Stroke or TIA: Blurry vision, dizziness, severe headache, weakness on one side of your body
• Arterial dissection: Stroke or heart attack-like symptoms or others, depending on the location

What can I expect if I have this condition?

Early diagnosis and treatment can give you a better prognosis.

There’s not a lot of research on how fibromuscular dysplasia affects life expectancy. In general, research shows that it doesn’t get worse over time. But it can lead to serious complications, like artery dissection and stroke.

Your healthcare provider will give you the best idea of what to expect based on your situation.

You may want to join advocacy organizations and support groups. These can connect you with others who have the same condition, which may also help raise awareness of FMD disease.