Fibromuscular dysplasia screening
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Fibromuscular dysplasia Microchapters |
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Diagnosis |
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Treatment |
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ASA/ACCF/AHA Guideline Recommendations |
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Management of Patients With Fibromuscular Dysplasia of the Extracranial Carotid Arteries |
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Case Studies |
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Fibromuscular dysplasia screening On the Web |
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American Roentgen Ray Society Images of Fibromuscular dysplasia screening |
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Risk calculators and risk factors for Fibromuscular dysplasia screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohsen Basiri M.D.
Overview
According to the American Heart Association (AHA)/American College of Cardiology guidelines, and European consensus on the diagnosis and management of fibromuscular dysplasia, there are some recommendations and indications for screening of FMD-related RAS ,cervicocephalic FMD, and in first-degree relatives of patients with FMD.
Screening
Renal artery fibromuscular dysplasia
- According to the American Heart Association (AHA) / American College of Cardiology guidelines, and European consensus on the diagnosis and management of fibromuscular dysplasia among patients with HTN, screening for FMD-related RAS is recommended in the following indications:[1][2]
- Age <30 years, especially in women
- Grade 3 (_180/110 mmHg), accelerated or malignant HTN,
- Resistant HTN (blood pressure target not achieved despite triple therapy at optimal doses including a diuretic)
- Small kidney without history of uropathy
- Abdominal bruit without apparent atherosclerosis
- FMD in at least another vascular territory
Fibromuscular dysplasia of the cervicocephalic arteries
Screening for FMD of the cervico-cephalic arteries should be considered in case of retinal or cerebral ischemic events, intracranial aneurysms, subarachnoid hemorrhage, cervical or intracranial dissections, or pulsatile tinnitus. However, it should be kept in mind that none of these symptoms are specific of FMD. In particular, the existence of intracranial aneurysms is not sufficient to establish the diagnosis of FMD.
Screening for fibromuscular dysplasia in first-degree relatives
- Hereditary FMD is possible in people with early-onset HTN, dissection, aneurysms, or cerebral hemorrhage.The presence of theses findings within the family members may provide an etiological clue, the patient must be informed about the possibility of hereditary FMD.
- Individuals with hereditary FMD are more often demonstrate multifocal and bilateral renal artery lesions in contrast to sporadic ones.
- A familial resemblance is observed in some relatives of FMD cases by high-resolution echo tracking of the carotid artery and analysis showed autosomal dominant inheritance. [3]
References
- ↑ Alan T. Hirsch, Ziv J. Haskal, Norman R. Hertzer, Curtis W. Bakal, Mark A. Creager, Jonathan L. Halperin, Loren F. Hiratzka, William R. C. Murphy, Jeffrey W. Olin, Jules B. Puschett, Kenneth A. Rosenfield, David Sacks, James C. Stanley, Lloyd M. Jr Taylor, Christopher J. White, John White, Rodney A. White, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Raymond J. Gibbons, Jonathan L. Halperin, Loren F. Hiratzka, Sharon A. Hunt, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2006). "ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation". Journal of the American College of Cardiology. 47 (6): 1239–1312. doi:10.1016/j.jacc.2005.10.009. PMID 16545667. Unknown parameter
|month=ignored (help) - ↑ Alexandre Persu, Alessandra Giavarini, Emmanuel Touze, Andrzej Januszewicz, Marc Sapoval, Michel Azizi, Xavier Barral, Xavier Jeunemaitre, Alberto Morganti, Pierre-Francois Plouin & Peter de Leeuw (2014). "European consensus on the diagnosis and management of fibromuscular dysplasia". Journal of hypertension. 32 (7): 1367–1378. doi:10.1097/HJH.0000000000000213. PMID 24842696. Unknown parameter
|month=ignored (help) - ↑ J. Perdu, P. Boutouyrie, C. Bourgain, N. Stern, B. Laloux, E. Bozec, M. Azizi, C. Bonaiti-Pellie, P.-F. Plouin, S. Laurent, A.-P. Gimenez-Roqueplo & X. Jeunemaitre (2007). "Inheritance of arterial lesions in renal fibromuscular dysplasia". Journal of human hypertension. 21 (5): 393–400. doi:10.1038/sj.jhh.1002156. PMID 17330059. Unknown parameter
|month=ignored (help)