Fibromuscular Dysplasia Masquerading as Peripheral Arterial Disease: Case Report

Purpose: To report a case of fibromuscular dysplasia (FMD) presenting with intermittent claudication successfully managed with endovascular therapy

Materials and Methods: FMD is a noninflammatory, nonatherosclerotic degenerative vascular disorder that may lead to arterial stenosis, occlusion, aneurysm, and dissection. FMD is more common in women, and the mean age at diagnosis is 52 years old. Although the exact etiology of FMD remains unknown, genetic, hormonal, and mechanical factors have been suggested. FMD has been observed in nearly every arterial bed; the most commonly involved arteries are the renal and extracranial cerebrovascular arteries. Because of this, the most common presenting symptoms of FMD are headache, pulsatile tinnitus, neck pain, and abdominal pain. Only two cases of FMD involving the external iliac artery (EIA) have been previously reported in the literature.

Results: An active 71-year-old woman presented with the chief complaint of bilateral lower extremity intermittent claudication after walking two blocks. The patient’s past medical history included hypertension, diabetes, and arthritis. The patient’s surgical history included hysterectomy and hemorrhoidectomy. Physical examination revealed intact motor and sensory function of the lower extremities, as well as intact peripheral pulses and deep tendon reflexes. She had an ankle–brachial index of 0.78 on the right and 0.73 on the left. Noninvasive testing was significant for dampened biphasic waveforms at the level of the bilateral common femoral arteries. After a trial of conservative medical management failed to alleviate her claudication, the patient elected to undergo further evaluation for suspected peripheral vascular disease. Aortoiliac and bilateral lower extremity angiography demonstrated a string-of-beads appearance of the bilateral external iliac arteries consistent with FMD. Otherwise, no evidence of significant atherosclerotic disease or irregularities of the lumen were noted in the abdominal aorta, visceral (renal), or lower extremity arteries. Prolonged inflation balloon angioplasty was performed on the bilateral EIAs using an 8-mm ´ 8-cm balloon. Postprocedure carotid ultrasound and computed tomography angiography of the brain were normal. At 2-week, 3-month, and 6-month follow-up, the patient denied recurrence of claudication.

Conclusions: FMD can involve the EIA and be associated with claudication. FMD of the EIA responds well to endovascular angioplasty.