What treatments are available for FMD?
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 your condition is, and your overall health.
If you have FMD but do not have any symptoms, you likely won’t need an interventional treatment. Your doctor may prescribe an antiplatelet medication (prescription medication or aspirin) to prevent blood clots. If you have high blood pressure in your renal arteries (renovascular hypertension) as a result of FMD, you may need to take medication to control your blood pressure. Common medications include angiotensin converting enzyme inhibitors (ACE-inhibitors) and angiotensin receptor blockers (ARBs).
If you have FMD and have frequent headaches, especially migraine headaches, your doctor may prescribe medication as treatment or prevention. If your headaches are severe and frequent, you may need to see a doctor who specializes in treating patients with headaches.
Identify and Treat Risk Factors
High blood pressure, diabetes and high cholesterol are all risk factors for vascular disease. It is important to be checked for these conditions and follow your treatment plan. It is also important not to smoke.
You may need to have regular testing, such as a duplex ultrasound, MRA or CTA, to monitor your condition. Testing is usually done once a year. These regular checks are especially important if you have an aneurysm or a carotid, vertebral, or renal artery dissection.
Your doctor may recommend that you have percutaneous angioplasty of the renal arteries. This procedure is similar to the procedure used to treat patients with blockages in the coronary arteries. Along, thin tube called a catheter with a tiny balloon on the end is inserted into the artery and guided to the narrowed/blocked area with the help of a special X-ray machine. Then, the balloon is inflated, which causes the blood vessel to re-open, and then the balloon and the catheter are removed.
Although it is common for patients who have angioplasty for heart-related problems to have a stent (small, metal mesh tube) placed in the area that is unblocked, there is no proof that stents improve outcomes related to renal angioplasty. In general, renal artery stents should only be used if angioplasty alone doesn’t restore proper blood flow to the kidneys or if they are needed to treat patients with a dissection (tear) in the renal artery.
Angioplasty may be recommended for patients with FMD of the internal carotid artery who have TIAs or stroke due to severe narrowing of the arteries. Stenting may also be needed in rare cases, such as when patients with FMD have had carotid or vertebral artery dissection that has not healed despite treatment with medication or who have a carotid aneurysm.
Your doctor may recommend reconstructive surgery if you have complex FMD of the renal arteries, depending on how severe the disease is and the areas affected. Surgery generally involves restoring blood flow by removing the blocked section of the artery or creating a bypass around the blockage. Surgery may also be the best option for patients who have an aneurysm but cannot be treated using catheter-based techniques.
FMD is a very different disorder than atherosclerosis (the build-up of plaque that is the most common cause of blocked arteries). Angioplasty and reconstructive surgery are technically demanding procedures and should be performed only by a physician experienced in these procedures and in the care of patients with FMD.