Kalavakunta Jagadeesh K, Tokala Hemasri, Gupta Vishal
Michigan State University/Kalamazoo Center for Medical Studies, Borgess Medical Center, Kalamazoo, MI, USA.
J Cardiol Cases. 2011 Jul 21;4(1):e50-e54. doi: 10.1016/j.jccase.2011.04.005. eCollection 2011 Aug.
Fibromuscular dysplasia (FMD) involving the renal arteries commonly presents as hypertension secondary to renal artery stenosis. Atypical patterns involving intima are rare and contribute to less than 10% cases of FMD. We present a relatively uncommon case of new onset hypertension in a 30-year-old woman resulting from intimal variant FMD involving the left renal artery. Renal duplex ultrasonography and angiography showed stenosis of the left renal artery consistent with intimal variant FMD. Percutaneous transluminal angioplasty of the stenotic lesion was successfully performed. Following angioplasty, her blood pressure was normalized. Renovascular hypertension secondary to FMD involving intimal layer is rare and requires a high index of clinical suspicion. Renal duplex ultrasonography is the recommended initial test of screening for renal artery stenosis in appropriate patients. The standard selective renal angiography, intravascular ultrasound, along with or without hemodynamic assessment should be utilized when renovascular intervention is contemplated. Percutaneous transluminal angioplasty is the mainstay of treatment for those who meet the criteria of intervention.
累及肾动脉的纤维肌发育不良（FMD）通常表现为继发于肾动脉狭窄的高血压。涉及内膜的非典型模式罕见，在FMD病例中占比不到10%。我们报告了一例相对罕见的30岁女性新发高血压病例，病因是累及左肾动脉的内膜型FMD。肾脏双功超声和血管造影显示左肾动脉狭窄，符合内膜型FMD。对狭窄病变成功进行了经皮腔内血管成形术。血管成形术后，她的血压恢复正常。继发于累及内膜层的FMD的肾血管性高血压罕见，需要高度的临床怀疑。肾脏双功超声是对合适患者进行肾动脉狭窄筛查的推荐初始检查。当考虑进行肾血管介入治疗时，应采用标准的选择性肾血管造影、血管内超声以及有或无血流动力学评估。经皮腔内血管成形术是符合干预标准者的主要治疗方法。
