title: Young Women with a Long Past of Resistant Hypertension Cured after Surgery of Severe Bilateral Ostial Renal Artery Stenosis.
abstract: Fibromuscular dysplasia (FMD) is an underdiagnosed disease which can affect young people and with poor prognosis such as dissection or aneurysm rupture if unknown. This case illustrates a multi-vessel FMD with symptomatic severe bilateral ostial renal artery stenosis and intracranial aneurysms. One of the original features is a very late delay to diagnosis with 23 years between onset of hypertension and renal stenosis diagnosis, particularly due to lower quality of initial CT scan with milder and uncommon abnormalities. The experiment neuroradiologist had suspected the diagnosis of renal FMD because she developed intracranial aneurysms and he confirmed this diagnosis with an artery renal contrast injection during an intracranial angiogram Because of very tight and short stenosis, surgery was chosen for treatment and permitted the cure of hypertension, with normal home blood pressure after 6 months. Several particularities of FMD were presented in this case: important delay diagnosis due to rare lesion and lower sensitivity of CT in this form, the possibility to perform an angiography in high suspicion of FMD, poor prognosis risk with intracranial aneurisms and premature birth child, and the choice for surgery with cure of hypertension. We thought that hypertension etiologic evaluation must be repeated in case of resistant hypertension in young patients, particularly when they developed intracranial aneurysms.
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Blandine
authors.initials: B
authors.lastname: Simonnet
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Deharo
authors.affiliation: Service de Radiologie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Rouabah
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Silhol
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Soler
authors.affiliation: Service de Radiologie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Bartoli
authors.affiliation: Service de Radiologie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lévrier
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Michel Alain
authors.initials: MA
authors.lastname: Bartoli
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France.
authors.forename: Pierre Edouard
authors.initials: PE
authors.lastname: Magnan
authors.affiliation: Service de Médecine et Chirurgie Vasculaire, Faculté de Médecine de Marseille, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille - Hôpital de la Timone, Marseille, France. Electronic address: gabrielle.sarlon@ap-hm.fr.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Sarlon-Bartoli
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D000072226:Computed Tomography Angiography; D057210:Delayed Diagnosis; D004351:Drug Resistance; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents