Clinical features and endovascular management of iliac artery fibromuscular dysplasia.
OBJECTIVE
To identify the spectrum of clinical presentation of iliac artery fibromuscular dysplasia (FMD) and to evaluate the outcomes of endovascular management of iliac artery FMD for claudication.


METHODS
All patients in a single institution with a diagnosis of FMD between January 1980 and December 2010 were identified. Iliac artery FMD was present in 14 patients. Associated risk factors included hypertension (79%), hyperlipidemia (64%), smoking history (36%), coronary artery disease (21%), diabetes (0%), and obesity (36%).


RESULTS
In eight (57%) patients, iliac artery FMD was incidentally found on imaging. Lifestyle-limiting claudication involving one or both extremities was present in six (43%) patients. All six patients were reported to have mild peripheral arterial disease based on ankle-brachial index measurements (0.7-0.9). These six patients underwent 10 endovascular procedures for claudication, including angioplasty (n = 8) and self-expanding stent placement (n = 2). Mean symptom-free survival was 56.3 months.


CONCLUSIONS
Iliac artery FMD that is amenable to endovascular treatment may be found incidentally or may manifest with disabling claudication.
Division of Cardiovascular Diseases, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902.
Siva S
SS
Ketha
Division of Vascular Interventional Radiology, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902.
Haraldur
H
Bjarnason
Department of Internal Medicine, Division of Vascular and Endovascular Surgery, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902.
Gustavo S
GS
Oderich
Division of Vascular Interventional Radiology, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902.. Electronic address: misra.sanjay@mayo.edu.
Sanjay
S
Misra
D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D018572:Disease-Free Survival; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D033162:Incidental Findings; D007383:Intermittent Claudication / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome