Fibromuscular Dysplasia of the Iliac and Renal Arteries: A Rare Case Report and Literature Review

Fibromuscular dysplasia(FMD) is a non-atherosclerotic arteriopathy affecting approximate all-sized vascular beds predominantly among women aging from 20 to 60 years. Iliac arterial FMD has not been precisely described regarding demographic, imaging and clinical features. We herein report the first case of bilateral common and internal iliac arterial FMD in China, with renal artery involvement discovered by computed resonance angiography(CTA) and contaminant stenosis, aneurysm and dissection. We then review all available cases concerning iliac arterial FMD particularly associated with dissection. A total of 111 cases(female, 84.7%), including the present case, have been reported. Median patient age was 52±12.8 years. Asymptomatic condition(49.5%) and claudication(40.5%) consisted the majority of clinical presentations, while bruit was the most frequent sign(64.9%) of 94 patients with physical examination data. External iliac artery involved was approximate threefold of common and internal iliac arteries. Other arteries particularly renal artery were also largely affected, alarming a system screening typically by CTA among iliac arterial FMD. Dissection accounted for 16.2% of iliac arterial FMD undergoing imaging, usually presenting ischemia symptoms with an inclination to young male patients. Conservative medication was efficient among 61.3% of reported iliac arterial FMD patients and percutaneous transluminal angioplasty(PTA) operated in 15 patients with satisfactory outcomes in 86.7%. Our patient was managed satisfactorily with angioplasty in renal artery and stenting in left iliac artery, presenting normotensive and asymptomatic off antihypertensive agents at 8-month follow-up. It is recommended that PTA is reasonable for renovascular hypertension with FMD and stenting seems to be promising for iliac arterial FMD with dissection.