Flashcards in Chap 102/147 FMD Deck (20):
What is FMD?
Non-athersclerotic noninflamm angiopathy of unknown cause. Medium sized vessels
What are complication of carotid FMD and how many get comps?
Decreased lumen size
Formation distal embolization of thrombus
What is the most common pathophys for cFMD?
medial fibroplasia 90%
What are most common concurrent lesion with cFMD?
ipsi bifurcation 20%
extracranial CA anerusy.
vert artery FMD
What are diagnostic methods?
duplex-may miss distal dz
angio--best, string of beads
CT-better then MRA
MRA-signal dropout may appear to be beads
What are therapeutic challenges for cFMD?
Difficult to quantify severity of disease
If concurrent lesion, difficult to determine which is causing symptoms
If ipsi sympto and contra asympto, difficult to know what to do with contra side
May have nonfocal symptoms due to global ischemia
Intracranial aneurysms may alter surgical approach
HTN from RA FMD may complicate sx on carotid FMD
What is conservative therapy for cFMD?
Monitor q6 months
Rule out involvement in other arterial beds
What are invasive treatment strategies?
Open surgical dilatation
Rigid dilators disrupt obstructive webs
May need to ivied belly of digastric muscle
Start with 1.5mm
10 year patency, stroke-free and survival all about 90%
Dilatation mainstay of treatment
Durability of PTA/stent unknown
May need to use external to get sheath/balloon up
Balloon should cover entire lesion and be slightly undersized to avoid dissection
Stent only if needed
What is the classification of FMD?
What is the most common type of FMD?
What are proposed cause of FMD?
May be hormonal factors
Occlusion of vaso vasorum
Long straight segs without branches are affected
CA and RA also get a lot of motion damaging VV.
Right renal longer so this may be why its affected more
What are most common patterns of involvement?
How common a cause of HTN is r FMD
2nd most common cause
What is the natural hx of r FDM?
About 25% of asympto devel HTN within 4 years
40% angio progression
decrease of renal funcition less frequent then with athererosclerotic
What are best tools for diagnosis?
DUS/CT/MRA are screening only because limited resolution for distal renal vessels
angio for diagnosis
What are indication for interventions for rFMD?
renal to aortic P gradient of 0.9
change in kidney size of 1 cm
impaired renal function
size difference of >1.5cm
pressure gradient across stenosis of 10mmhg
What are indications for evaluation of secondary HTN?
sudden acceleration of CR or HTN
increased CR with ACEi
unexplained pulm edema
What are medical treatments for rFMD?
Anti-htn treatment <140/90
What are surgical options for rFMD?