title: Lower Extremity Fibromuscular Dysplasia: Clinical Manifestations, Diagnostic Testing, and Approach to Management.
abstract: Fibromuscular dysplasia (FMD), a disease well described in the renal and cerebrovascular circulations, also manifests in the lower extremity (LE) arteries. This study reports on the clinical presentation, imaging findings, and treatment of patients with LE FMD seen at a single center. Over a 7-year span, 100 of 449 patients with FMD had imaging of the LE arteries, of which 62 were found to have LE FMD (13.8% of the entire FMD cohort including patients with and without LE imaging). The majority of patients were women (96.8%), with an average age of 52 ± 11.3 years at the time of diagnosis. All patients had FMD present in another vascular bed, most commonly in the renal (80.6%) and extracranial carotid arteries (79.0%). Most patients had multifocal FMD (95.2%) and bilateral LE disease (69.4%), with the external (87.1%), common (19.4%), and internal (11.3%) iliac arteries most commonly affected. Presenting symptoms of LE involvement included claudication (22.6%), atypical leg symptoms (14.5%), and dissection (6.5%), but most patients were asymptomatic (71.0%). Nearly all patients were managed conservatively (98.4%) and only 1 patient required intervention.
authors.affiliation: 1 Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Brinza
authors.affiliation: 1 Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lenihan
authors.affiliation: 2 Department of Cardiovascular Medicine, Borgess Medical Center, Kalamazoo, MI, USA.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Durga
authors.affiliation: 3 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: O'Connor
authors.affiliation: 1 Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Yesenko
authors.affiliation: 1 Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Esther S H
authors.initials: ESH
authors.lastname: Kim
authors.affiliation: 1 Section of Vascular Medicine, Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072700:Conservative Treatment; D003937:Diagnosis, Differential; D005260:Female; D005352:Fibromuscular Dysplasia / Q000000981:diagnostic imaging* / Q000628:therapy*; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012042:Registries; D016896:Treatment Outcome; D014481:United States
keywords: arterial dissection; external iliac artery; fibromuscular dysplasia (FMD); intermittent claudication; vascular imaging