Table 5.

Clinical Pearls in Managing the Patient With FMD

In addition to a complete vascular review of systems, query the FMD patient for common and quality of life impairing symptoms such as migraine headaches, pulsatile tinnitus, and neck pain

FMD patients should undergo screening for occult aortic or arterial aneurysms as clinically indicated. All patients with FMD should be screened for intracranial aneurysm at least once with MRA or CTA. The subsequent imaging surveillance program is customized to the location and severity of arterial lesions identified

Obtain a complete family history from the FMD patient, not only for family members with confirmed diagnosis of FMD, but also for stroke, MI, aneurysms, dissections, vascular procedures, and sudden death

Reserve genetic testing for connective tissue disorders such as Ehlers‐Danlös and Loeys‐Dietz for select patients with suggestive clinical features, family history, or imaging findings that are atypical for FMD

In the absence of a contraindication, most FMD patients (eg, cerebrovascular FMD, prior revascularization) should be treated with an anti‐platelet agent to prevent thromboembolic events

Reserve renal PTA for FMD patients who have a significant likelihood of clinical success and who have significant pressure gradients across the renal artery

Renal artery stenting for FMD is generally reserved for treatment of dissection or when balloon angioplasty has failed

In general, do not intervene on patients with asymptomatic FMD, except in the case of sizable arterial aneurysm for which the risk of rupture is significant

FMD indicates fibromuscular dysplasia; MRA, magnetic resonance angiography; CTA, computed tomography angiography; PTA, percutaneous transluminal angioplasty.