Treatment

Treatment for fibromuscular dysplasia depends on your health, the location of the narrowed artery and other underlying conditions you have, such as high blood pressure. Treatment options include medical procedures, surgery and medications.

Medical procedures and surgery

For otherwise healthy people with fibromuscular dysplasia, repairing the affected artery is often recommended. The procedures to improve blood flow can include:

  • Percutaneous transluminal angioplasty (PTA). This procedure is usually preferred over surgery. It is often performed at the same time as a catheter-based angiogram.

    Once the dye from the angiogram shows the narrowed area of the artery, a wire is threaded to the artery and a catheter with a balloon is inserted in the narrowed area. The balloon is then inflated to open the narrowed part of the artery.

    Unlike the angioplasty procedures performed on people with heart disease, a stent may not be necessary to keep the artery open.

  • Surgical revascularization. If PTA is not an option, and the narrowing of your arteries is severe, your doctor may recommend more-invasive surgery to repair the narrowed portion of the artery. The type of surgery you'll need depends on the location of the narrowed artery and how damaged the artery is.

    The most commonly performed type of revascularization surgery is an aortorenal bypass. This type of procedure involves replacing the artery that leads to the kidney with a vein from the leg.

If your doctor finds serious damage related to fibromuscular dysplasia, such as an aneurysm, he or she may recommend placing a metal mesh tube (stent) inside the weakened part of the artery to help prevent it from rupturing.

Drugs

Treatment with high blood pressure medications is recommended for most people with fibromuscular dysplasia, even if they also have a procedure to correct the condition. These could include medications from several categories:

  • Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), enalapril (Vasotec) or lisinopril (Prinivil, Zestril), stop the narrowing of your blood vessels.
  • Angiotensin II receptor blockers. These medications help relax your blood vessels by blocking the action of a natural chemical that narrows blood vessels. Examples of this class of medications include candesartan (Atacand), irbesartan (Avapro), losartan (Cozaar) and valsartan (Diovan).
  • Diuretics. These drugs, such as hydrochlorothiazide (Microzide, others), help remove excess fluid from your body and may be used in conjunction with other blood pressure medications.
  • Calcium channel blockers, such as amlodipine (Norvasc) or nifedipine (Adalat CC, Afeditab CR, Procardia) and others, help relax your blood vessels.
  • Beta blockers, such as metoprolol (Lopressor, Toprol-XL) or atenolol (Tenormin) and others, slow your heartbeat and block adrenaline.

Because some of these drugs can affect the way your kidneys work, your doctor may recommend blood tests and a urine test (urinalysis) to make sure your kidneys work normally once these medications have been started.

Your doctor may also suggest you take a daily aspirin to reduce your risk of stroke. But don't start taking an aspirin without discussing it with your doctor first.

If you smoke, another part of your treatment plan is to stop smoking. Smoking may make fibromuscular dysplasia worse.

May 03, 2016
References
  1. Olin JW. Clinical manifestations and diagnosis of fibromuscular dysplasia. http://www.uptodate.com/home. Accessed Feb. 10, 2016.
  2. Poloskey SL, et al. Fibromuscular dysplasia. Circulation. 2012;125:e636.
  3. What is FMD? Fibromuscular Dysplasia Society of America. http://www.fmdsa.org/fmd_info/what_is_fmd. Accessed Feb. 10, 2016.
  4. Olin JW. Treatment of fibromuscular dysplasia of the renal arteries. http://www.uptodate.com/home. Accessed Feb. 10, 2016.
  5. Fibromuscular dysplasia information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/fibromuscular_dysplasia/fibromuscular_dysplasia.htm. Accessed Feb. 10, 2016.
  6. Riggin ER. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Jan. 15, 2016.
  7. Rooke TW (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 17, 2016.
  8. Mankad R (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 28, 2016.
  9. Tweet MS, et al. What clinicians should know about spontaneous coronary artery dissection. Mayo Clinic Proceedings. 2015;90:1125.