Arterial fibromuscular disease. Observations on pathogenesis and surgical management

Fibromuscular dysplasia is being recognized more often as a significant pathologic vascular disease separate from atherosclerosis. The pathogenesis and pathology are still being investigated. This disease involves mainly three areas--renal, carotid and iliac arteries--with the renal area being the most common. Surgery has been used almost exclusively for symptomatic lesions, and the indications and procedures have been refined since the original procedures of resection and grafting. In patients with renal involvement, we first attempt to treat hypertension medically, followed by surgery if this is unsuccessful. In those with carotid involvement, we are very aggressive with symptomatic lesions since there is a 22 percent incidence of a significant preceding event in the patients operated on. In patients with iliac involvement, we treat according to symptoms. Graduated internal dilatation has been used very successfully alone and in combination with other methods. Postoperative follow-up and arteriography have shown the effects of surgery to be lasting and rewarding, with minimal morbidity and mortality and no recurrence.