An unusual case of fibromuscular dysplasia

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Cardiovascular Medicine

Background:

• Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disease that can affect various arteries, leading to stenosis, occlusion, or aneurysms.
• Abdominal angina, or chronic mesenteric ischemia, results from insufficient blood flow to the intestines, often caused by stenosis or occlusion of the mesenteric arteries.
• The management of extensive arterial involvement in FMD can be challenging, requiring innovative surgical approaches.

Observation:

• A patient presented with symptoms of abdominal angina attributed to fibromuscular dysplasia.
• Arteriography demonstrated FMD in both renal arteries and occlusion at the origins of the coeliac and mesenteric arteries.
• Further digital subtraction angiography revealed FMD affecting both carotid artery systems.

Findings:

• A unique surgical solution involved anastomosing an elongated right internal iliac artery to the superior mesenteric artery.
• This reconstructive procedure aimed to restore adequate blood flow to the mesenteric circulation.
• Post-operative follow-up confirmed the long-term patency of the engineered bypass graft.

Implications:

• This case highlights the potential for fibromuscular dysplasia to cause multi-arterial disease, including mesenteric and carotid involvement.
• It demonstrates the feasibility of a complex arterial reconstruction using autologous tissue for managing chronic mesenteric ischemia secondary to FMD.
• The successful outcome suggests that such unconventional surgical strategies may be viable options in select FMD patients with extensive occlusive disease.