Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Faculty of Health, Aarhus University, Aarhus, Denmark.
J Clin Hypertens (Greenwich). 2024 Aug;26(8):890-901. doi: 10.1111/jch.14865. Epub 2024 Jul 16.
Fibromuscular dysplasia (FMD) is a disease of the musculature of arterial walls leading to stenoses, aneurysms, and dissections. The purpose of this report was to summarize the evidence for (1) one-time routine imaging from brain-to-pelvis and (2) lifelong antiplatelet therapy, for example, aspirin, for patients diagnosed with FMD as suggested by an international consensus report from 2019. PubMed was systematically searched, and the evidence providing a basis for the current consensus points, as well as articles published since, were reviewed. In four registries evaluating patients with FMD, the prevalence of multivessel involvement, aneurysms, and dissections was reported to be 43.5%-66.3%, 21.6%-30.6%, and 5.6%-28.1%, respectively. Any antiplatelet drug was used in 72.9% of patients, and aspirin was prescribed in up to 70.2% of patients. Based on the high prevalence of vascular manifestations, their associated morbidity, and the potential for endovascular or surgical intervention, the suggestion of one-time brain-to-pelvis screening with computed tomography angiography or magnetic resonance angiography is well supported. Contrarily, the evidence to support the consensus statement of lifelong antiplatelet therapy to all patients in the absence of contraindications is more uncertain since a beneficial effect has not been demonstrated specifically in patients with fibromuscular dysplasia. Therefore, until the efficacy and safety of primary thromboprophylaxis have been demonstrated in this patient group specifically, it may be equally appropriate to only use antiplatelet agents in patients with a clear indication after individual evaluation according to risk factors for thrombotic and thromboembolic complications.
纤维肌性发育不良（FMD）是一种动脉壁肌肉疾病，可导致狭窄、动脉瘤和夹层。本报告的目的是总结 2019 年国际共识报告建议的证据：（1）对脑至骨盆进行一次性常规成像，（2）例如阿司匹林，对诊断为 FMD 的患者进行终生抗血小板治疗。系统地检索了 PubMed，并对为当前共识点提供依据的证据以及自那以后发表的文章进行了回顾。在四项评估 FMD 患者的登记研究中，报道多血管受累、动脉瘤和夹层的患病率分别为 43.5%-66.3%、21.6%-30.6%和 5.6%-28.1%。72.9%的患者使用了任何一种抗血小板药物，多达 70.2%的患者开了阿司匹林。基于血管表现的高患病率、其相关发病率以及血管内或手术干预的可能性，建议对脑至骨盆进行一次性 CT 血管造影或磁共振血管造影筛查。相反，鉴于尚未明确证明纤维肌性发育不良患者具有特定获益，支持无禁忌症的所有患者终生抗血小板治疗的共识声明的证据更加不确定。因此，在该患者组中具体证明初级血栓预防的疗效和安全性之前，根据血栓形成和血栓栓塞并发症的危险因素，根据个体评估仅对有明确适应证的患者使用抗血小板药物可能同样合适。
