[MO-64] Presentation Awards
Brachial artery aneurysm and thrombosis secondary to fibromuscular dysplasia
We present the unusual case of brachial artery fibromuscular dysplasia (FMD) in a male patient with no pre-existing risk factors. He presented with 2 weeks of right arm pain and a cool right hand without neurologic deficiency. Investigations showed a thrombosed & occluded brachial artery aneurysm. This was managed with an open procedure with excision of the aneurysmal segment, thrombectomy & venous interposition graft. The patient made a full recovery. Histopathological examination of the excised segment showed intimal fibroplasia a less common form of FMD.
FMD is a rare arterial disorder affecting small to medium-sized arteries. It is characterised by dysplastic changes in one of the arterial layers, leading to stenosis with or without dilation. The most commonly affected arteries are the renal and carotid arteries; hence, renovascular hypertension and neurologic symptoms are the most common presenting signs and symptoms. However, it has been documented in virtually all small- and medium-calibre arteries. Definitive diagnosis is on histopathology but classic “string of beads” appearance on angiography is often accepted as diagnostic of FMD. Risk factors in the development of FMD include family history of FMD, smoking, and hypertension; FMD typically affects young to middle-aged women.
The surgical management of symptomatic or clinically significant FMD is balloon angioplasty, although open resection of the affected artery remains a treatment option in some clinical contexts, as demonstrated in this case.
While uncommon, FMD remains an important differential diagnosis in the evaluation of arterial insufficiency and stenosis. FMD can typically be distinguished from atherosclerotic disease by the lesion’s location and lack of vascular risk factors. Importantly, because FMD affects multiple vascular beds in 28% of cases, screening of the most commonly affected sites, the renal and cervicocerebral arteries, should be undertaken in all patients diagnosed as having FMD.
FMD is a rare arterial disorder affecting small to medium-sized arteries. It is characterised by dysplastic changes in one of the arterial layers, leading to stenosis with or without dilation. The most commonly affected arteries are the renal and carotid arteries; hence, renovascular hypertension and neurologic symptoms are the most common presenting signs and symptoms. However, it has been documented in virtually all small- and medium-calibre arteries. Definitive diagnosis is on histopathology but classic “string of beads” appearance on angiography is often accepted as diagnostic of FMD. Risk factors in the development of FMD include family history of FMD, smoking, and hypertension; FMD typically affects young to middle-aged women.
The surgical management of symptomatic or clinically significant FMD is balloon angioplasty, although open resection of the affected artery remains a treatment option in some clinical contexts, as demonstrated in this case.
While uncommon, FMD remains an important differential diagnosis in the evaluation of arterial insufficiency and stenosis. FMD can typically be distinguished from atherosclerotic disease by the lesion’s location and lack of vascular risk factors. Importantly, because FMD affects multiple vascular beds in 28% of cases, screening of the most commonly affected sites, the renal and cervicocerebral arteries, should be undertaken in all patients diagnosed as having FMD.