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 renal angioplasty (PTRA). 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.
PTRA is usually performed while you're awake, although you'll be given a sedative to relax during the procedure. The procedure takes about one to two hours.
- Surgical revascularization. If PTRA 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. These procedures require general anesthesia, meaning you'll be unconscious during the surgery.
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.
Treatment with high blood pressure medications is recommended for most people with fibromuscular dysplasia, even if you also have a procedure to correct your 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 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 (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 also may 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're a smoker, another part of your treatment plan is to stop smoking. Smoking may make fibromuscular dysplasia worse.
May 24, 2013
- Poloskey, SL, et al. Fibromuscular dysplasia. Cardiology patient page. Circulation. 2012;125:e636-e639.
- Olin, JW, et al. The United States registry for fibromuscular dysplasia: Results in the first 447 patients. Circulation. 2012;125:3182.
- Slovut DP, et al. Clinical manifestations and diagnosis of fibromuscular dysplasia. http://www.uptodate.com/home. Accessed March 7, 2013.
- Slovut DP, et al. Treatment of fibromuscular dysplasia of the renal arteries. http://www.uptodate.com/home. Accessed March 7, 2013.
- Olin JW, et al. Diagnosis, management, and future developments of fibromuscular dysplasia. Journal of Vascular Surgery. 2011;53:826.