Fibromuscular dysplasia, or FMD, can cause arteries throughout the body to either narrow or bulge.
FMD often occurs in arteries in or near the brain.
Left untreated, FMD can lead to aneurysms or a stroke.
Learn more about how to identify and manage this potentially dangerous condition.
Selected Podcast
Identifying and Managing Fibromuscular Dysplasia
Featured Speaker:
Organization: UVA Heart & Vascular Center
Dr. Aditya Sharma
Dr. Aditya Sharma is a vascular medicine specialist at the UVA Heart & Vascular Center. He specializes in conditions such as aneurysms, deep vein thrombosis, peripheral arterial disease and fibromuscular dysplasia.Organization: UVA Heart & Vascular Center
Transcription:
Identifying and Managing Fibromuscular Dysplasia
Melanie Cole (Host): Fibromuscular dysplasia or FMD can cause arteries throughout the body to either narrow or bulge, and if it's left untreated, it can lead to aneurysms or stroke. My guest is Aditya Sharma. He's a vascular medicine specialist at the UVA Heart and Vascular Center. Welcome to the show, Dr. Sharma. Tell the listeners a little bit about FMD, if you would.
Dr. Aditya Sharma (Guest): Sure, Melanie. Thank you for inviting me over to your show. Fibromuscular dysplasia is a condition of the blood vessels where we see narrowing as well as enlargement of the arteries in different parts of the body. Interestingly, the narrowing and enlargement are right next to each other. So the blood vessels appear like a string of beads when we look at it on a CAT scan or MRI. When the narrowing is too bad or too narrow, then it can actually cause decreased blood supply to whatever organs that area is supplying, which can cause problems. If the enlargement is too enlarged, then of course, there's a risk of rupture and having more problems from that.
Melanie: Are there certain people that are at higher risk for this, for FMD?
Dr. Sharma: Yes, certainly. In fact, nine out of ten times, we see FMD in women specifically in their thirties to fifties. So relatively younger women are more affected by this disease. It is not a very common disease. In fact, it is seen in probably less than one percent of the entire population. But we think one of the reasons of it being so uncommon is the fact that we are perhaps not diagnosing it as frequently as we should.
Melanie: Okay. So what would be the symptoms, even if it is rather rare? If somebody was subject to this, how would they even know?
Dr. Sharma: The symptoms depend upon which blood vessels in the body are affected. One of the most common locations is the arteries supplying the kidneys, which are the renal arteries. If fibromuscular dysplasia occurs in those particular blood vessels, then frequently, people suffer from severe hypertension, especially which would be very uncommon typically wouldn't see a 30-year-old lady suffering from severe hypertension, but this would be one of those presenting features. The other thing is that they may sometimes complain of low back pain around the area of the kidneys. Now, if it occurs in the blood vessels of the neck, which are the carotid arteries and the vertebral arteries, which are, again, a very common place to have fibromuscular dysplasia, then these people suffer from migraine headaches and in fact hear a squishing sound in their ears. They may have ringing in their ears that occurs all the time. The biggest problem that they frequently see is that people with fibromuscular dysplasia are at risk of tearing their arteries spontaneously, which can -- if it occurs in the neck blood vessels, then it can lead to stroke.
Melanie: Wow. So if you have any of these symptoms and the back pain near the kidney, or you hear that squishing sound that seems to be pretty telltale, you go to see a vascular medicine specialist such as yourself. How is this diagnosed? It's MRI, you mentioned a little bit, before?
Dr. Sharma: Exactly. A lot of times, we start diagnosing or look for --first of all, we make sure that there are not other causes that could be leading to these problems. However, sometimes, some of these symptoms appear very classic for this particular disease and in those situations, we may start with an ultrasound first, as it's the most non-invasive form of imaging. And eventually, for final diagnosis, though, after getting an MRI, for some areas, a CAT scan is better. At times, we have to proceed with doing a conventional angiography, which is basically putting a catheter through the blood vessels and shooting some die to look in the blood vessels. Typically, we will see the string of bead up here in the blood vessels which are affected.
Melanie: It sounds that this is also similar to atherosclerosis which is quite, quite common. So when you're looking, you're really discerning between the two, correct?
Dr. Sharma: Right, exactly. In fact, it's very interesting because it occurs in the same blood vessels and arteries as atherosclerosis, but the location is quite different. That's one of the reason we actually are able to identify or separate this disease from atherosclerosis. Atherosclerosis, typically, in these blood vessels, would occur at the origin of the blood vessels. So when these blood vessels—like for instance, the renal arteries, the kidney blood vessels—the common location where atherosclerosis would occur is right when the renal artery gets off the main aorta. So it's right at the origin, so to say. However, fibromuscular dysplasia occurs more at the end of the blood vessels, so distally, where we typically will not see atherosclerosis. That's one of the ways we differentiate it. Plus, with atherosclerosis, you tend to have more of this narrowing at one area with a lot of cholesterol plaque around it. With fibromuscular dysplasia, we do see narrowing, but there are multiple narrowings most of the time with sort of this bulging up here, which we won't see with athero. That's sort of another way we differentiate it. Also, what they don't notice with that is it is very unlikely especially to see women in their thirties and forties to present with such severe atherosclerosis. So, those are one of those differentiating factors, how we figure out one from the other.
Melanie: That's true. It is. Dr. Sharma, once you have diagnosed FMD, what are the treatments? Are medications similar to atherosclerosis? Are we doing blood thinners for the narrowing? How does that work?
Dr. Sharma: That's a very good question. Some of the treatment is very similar to atherosclerosis, but then there are actually some major differences, and this is why it is very important that these patients with fibromuscular dysplasia come see a proper specialist. For most Asians with fibromuscular dysplasia, we will keep them on a blood thinner, which primarily is aspirin but sometimes we may use other blood thinners, still. If the narrowing is too severe and it is affecting that particular blood vessel area that it's supplying, this could be -- if it's the kidneys and the narrowing is so severe that it's leading to severe high blood pressure, then what we do is we do an angioplasty, where we put in a catheter and basically, the catheter has a balloon on it, which opens up and dilates those areas of narrowing. The main difference in those terms is that with atherosclerosis, you typically tend to put a stent in these patients. We actually differ from putting a stent in, as that area where this narrowing occurs is very flexible, and a stent can actually cause more problems by getting broken or fractured in those areas. So those are the sort of the small differences that we look at. If the bulging is too large, then there's all this risk that that area could rupture, the blood vessels could break down and cause bleeding. So in those situations, we actually repair them, either by surgery or by putting a stent to that area.
Melanie: Dr. Sharma, what is UVA's experience in years with treating FMD?
Dr. Sharma: UVA has a lot of experience in treating FMD. I know that physicians at UVA had been seeing patients with fibromuscular dysplasia for over two decades. We have publications coming out of UVA almost 15 years ago, and we frequently see those. In fact, in this particular area, UVA is considered one of the major centers of excellence for fibromuscular dysplasia. I know that we have seen over 200 to 250 patients with fibromuscular dysplasia in the last, maybe, five to ten years, which is a whole lot for a rare disease like this. And we frequently communicate with other areas or centers of excellence with fibromuscular dysplasia, so we try to be up to the standards of care that is being performed all over the world for this disease.
Melanie: That's really amazing. In 20 seconds, Dr. Sharma, wrap this up and give your best advice about FMD.
Dr. Sharma: If you have any of these symptoms that we just talked about, such as squishing in the inner ears, ringing in your ears or severe hypertension at an unusual young age, talk to your doctor about this disease and have them check it out. If you are diagnosed with this disease, I think it's very important to see a particular specialist who specializes in this particular disease. One of the best websites to go to is fmdsa.org, where you can find the major centers of excellence closest to you.
Melanie: Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
Identifying and Managing Fibromuscular Dysplasia
Melanie Cole (Host): Fibromuscular dysplasia or FMD can cause arteries throughout the body to either narrow or bulge, and if it's left untreated, it can lead to aneurysms or stroke. My guest is Aditya Sharma. He's a vascular medicine specialist at the UVA Heart and Vascular Center. Welcome to the show, Dr. Sharma. Tell the listeners a little bit about FMD, if you would.
Dr. Aditya Sharma (Guest): Sure, Melanie. Thank you for inviting me over to your show. Fibromuscular dysplasia is a condition of the blood vessels where we see narrowing as well as enlargement of the arteries in different parts of the body. Interestingly, the narrowing and enlargement are right next to each other. So the blood vessels appear like a string of beads when we look at it on a CAT scan or MRI. When the narrowing is too bad or too narrow, then it can actually cause decreased blood supply to whatever organs that area is supplying, which can cause problems. If the enlargement is too enlarged, then of course, there's a risk of rupture and having more problems from that.
Melanie: Are there certain people that are at higher risk for this, for FMD?
Dr. Sharma: Yes, certainly. In fact, nine out of ten times, we see FMD in women specifically in their thirties to fifties. So relatively younger women are more affected by this disease. It is not a very common disease. In fact, it is seen in probably less than one percent of the entire population. But we think one of the reasons of it being so uncommon is the fact that we are perhaps not diagnosing it as frequently as we should.
Melanie: Okay. So what would be the symptoms, even if it is rather rare? If somebody was subject to this, how would they even know?
Dr. Sharma: The symptoms depend upon which blood vessels in the body are affected. One of the most common locations is the arteries supplying the kidneys, which are the renal arteries. If fibromuscular dysplasia occurs in those particular blood vessels, then frequently, people suffer from severe hypertension, especially which would be very uncommon typically wouldn't see a 30-year-old lady suffering from severe hypertension, but this would be one of those presenting features. The other thing is that they may sometimes complain of low back pain around the area of the kidneys. Now, if it occurs in the blood vessels of the neck, which are the carotid arteries and the vertebral arteries, which are, again, a very common place to have fibromuscular dysplasia, then these people suffer from migraine headaches and in fact hear a squishing sound in their ears. They may have ringing in their ears that occurs all the time. The biggest problem that they frequently see is that people with fibromuscular dysplasia are at risk of tearing their arteries spontaneously, which can -- if it occurs in the neck blood vessels, then it can lead to stroke.
Melanie: Wow. So if you have any of these symptoms and the back pain near the kidney, or you hear that squishing sound that seems to be pretty telltale, you go to see a vascular medicine specialist such as yourself. How is this diagnosed? It's MRI, you mentioned a little bit, before?
Dr. Sharma: Exactly. A lot of times, we start diagnosing or look for --first of all, we make sure that there are not other causes that could be leading to these problems. However, sometimes, some of these symptoms appear very classic for this particular disease and in those situations, we may start with an ultrasound first, as it's the most non-invasive form of imaging. And eventually, for final diagnosis, though, after getting an MRI, for some areas, a CAT scan is better. At times, we have to proceed with doing a conventional angiography, which is basically putting a catheter through the blood vessels and shooting some die to look in the blood vessels. Typically, we will see the string of bead up here in the blood vessels which are affected.
Melanie: It sounds that this is also similar to atherosclerosis which is quite, quite common. So when you're looking, you're really discerning between the two, correct?
Dr. Sharma: Right, exactly. In fact, it's very interesting because it occurs in the same blood vessels and arteries as atherosclerosis, but the location is quite different. That's one of the reason we actually are able to identify or separate this disease from atherosclerosis. Atherosclerosis, typically, in these blood vessels, would occur at the origin of the blood vessels. So when these blood vessels—like for instance, the renal arteries, the kidney blood vessels—the common location where atherosclerosis would occur is right when the renal artery gets off the main aorta. So it's right at the origin, so to say. However, fibromuscular dysplasia occurs more at the end of the blood vessels, so distally, where we typically will not see atherosclerosis. That's one of the ways we differentiate it. Plus, with atherosclerosis, you tend to have more of this narrowing at one area with a lot of cholesterol plaque around it. With fibromuscular dysplasia, we do see narrowing, but there are multiple narrowings most of the time with sort of this bulging up here, which we won't see with athero. That's sort of another way we differentiate it. Also, what they don't notice with that is it is very unlikely especially to see women in their thirties and forties to present with such severe atherosclerosis. So, those are one of those differentiating factors, how we figure out one from the other.
Melanie: That's true. It is. Dr. Sharma, once you have diagnosed FMD, what are the treatments? Are medications similar to atherosclerosis? Are we doing blood thinners for the narrowing? How does that work?
Dr. Sharma: That's a very good question. Some of the treatment is very similar to atherosclerosis, but then there are actually some major differences, and this is why it is very important that these patients with fibromuscular dysplasia come see a proper specialist. For most Asians with fibromuscular dysplasia, we will keep them on a blood thinner, which primarily is aspirin but sometimes we may use other blood thinners, still. If the narrowing is too severe and it is affecting that particular blood vessel area that it's supplying, this could be -- if it's the kidneys and the narrowing is so severe that it's leading to severe high blood pressure, then what we do is we do an angioplasty, where we put in a catheter and basically, the catheter has a balloon on it, which opens up and dilates those areas of narrowing. The main difference in those terms is that with atherosclerosis, you typically tend to put a stent in these patients. We actually differ from putting a stent in, as that area where this narrowing occurs is very flexible, and a stent can actually cause more problems by getting broken or fractured in those areas. So those are the sort of the small differences that we look at. If the bulging is too large, then there's all this risk that that area could rupture, the blood vessels could break down and cause bleeding. So in those situations, we actually repair them, either by surgery or by putting a stent to that area.
Melanie: Dr. Sharma, what is UVA's experience in years with treating FMD?
Dr. Sharma: UVA has a lot of experience in treating FMD. I know that physicians at UVA had been seeing patients with fibromuscular dysplasia for over two decades. We have publications coming out of UVA almost 15 years ago, and we frequently see those. In fact, in this particular area, UVA is considered one of the major centers of excellence for fibromuscular dysplasia. I know that we have seen over 200 to 250 patients with fibromuscular dysplasia in the last, maybe, five to ten years, which is a whole lot for a rare disease like this. And we frequently communicate with other areas or centers of excellence with fibromuscular dysplasia, so we try to be up to the standards of care that is being performed all over the world for this disease.
Melanie: That's really amazing. In 20 seconds, Dr. Sharma, wrap this up and give your best advice about FMD.
Dr. Sharma: If you have any of these symptoms that we just talked about, such as squishing in the inner ears, ringing in your ears or severe hypertension at an unusual young age, talk to your doctor about this disease and have them check it out. If you are diagnosed with this disease, I think it's very important to see a particular specialist who specializes in this particular disease. One of the best websites to go to is fmdsa.org, where you can find the major centers of excellence closest to you.
Melanie: Thank you so much. You're listening to UVA Health System Radio. For more information, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.