Dissection and Aneurysm in Patients With Fibromuscular Dysplasia: Findings From the U.S. Registry for FMD

Daniella Kadian-Dodov, Heather L. Gornik, Xiaokui Gu, James Froehlich, J. Michael Bacharach, Yung-wei Chi, Bruce H. Gray, Michael R. Jaff, Esther S H Kim, Pamela Mace, Aditya Sharma, Eva Kline-Rogers, Christopher White, Jeffrey W. Olin

Research output: Contribution to journalArticle

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Abstract

Background Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. Objectives This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without. Methods The U.S. Registry for FMD involves 12 clinical centers. This analysis included clinical history, diagnostic, and therapeutic procedure results for 921 FMD patients enrolled in the registry as of October 17, 2014. Results Aneurysm occurred in 200 patients (21.7%) and dissection in 237 patients (25.7%); in total, 384 patients (41.7%) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were younger at presentation (48.4 vs. 53.5 years of age, respectively; p < 0.0001) and experienced more neurological symptoms and other end-organ ischemic events than those without dissection. One-third of aneurysm patients (63 of 200) underwent therapeutic intervention for aneurysm repair. Conclusions Patients with FMD have a high prevalence of aneurysm and/or dissection prior to or at the time of FMD diagnosis. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.

Original languageEnglish (US)
Pages (from-to)176-185
Number of pages10
JournalJournal of the American College of Cardiology
Volume68
Issue number2
DOIs
StatePublished - Jul 12 2016

Fingerprint

Fibromuscular Dysplasia
Aneurysm
Registries
Dissection
Renal Artery
Vertebral Artery
Magnetic Resonance Angiography
Pelvis
Carotid Arteries

Keywords

  • angiography
  • beading
  • stenosis
  • tortuosity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dissection and Aneurysm in Patients With Fibromuscular Dysplasia : Findings From the U.S. Registry for FMD. / Kadian-Dodov, Daniella; Gornik, Heather L.; Gu, Xiaokui; Froehlich, James; Bacharach, J. Michael; Chi, Yung-wei; Gray, Bruce H.; Jaff, Michael R.; Kim, Esther S H; Mace, Pamela; Sharma, Aditya; Kline-Rogers, Eva; White, Christopher; Olin, Jeffrey W.

In: Journal of the American College of Cardiology, Vol. 68, No. 2, 12.07.2016, p. 176-185.

Research output: Contribution to journalArticle

Kadian-Dodov, D, Gornik, HL, Gu, X, Froehlich, J, Bacharach, JM, Chi, Y, Gray, BH, Jaff, MR, Kim, ESH, Mace, P, Sharma, A, Kline-Rogers, E, White, C & Olin, JW 2016, 'Dissection and Aneurysm in Patients With Fibromuscular Dysplasia: Findings From the U.S. Registry for FMD', Journal of the American College of Cardiology, vol. 68, no. 2, pp. 176-185. https://doi.org/10.1016/j.jacc.2016.04.044
Kadian-Dodov, Daniella ; Gornik, Heather L. ; Gu, Xiaokui ; Froehlich, James ; Bacharach, J. Michael ; Chi, Yung-wei ; Gray, Bruce H. ; Jaff, Michael R. ; Kim, Esther S H ; Mace, Pamela ; Sharma, Aditya ; Kline-Rogers, Eva ; White, Christopher ; Olin, Jeffrey W. / Dissection and Aneurysm in Patients With Fibromuscular Dysplasia : Findings From the U.S. Registry for FMD. In: Journal of the American College of Cardiology. 2016 ; Vol. 68, No. 2. pp. 176-185.
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abstract = "Background Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. Objectives This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without. Methods The U.S. Registry for FMD involves 12 clinical centers. This analysis included clinical history, diagnostic, and therapeutic procedure results for 921 FMD patients enrolled in the registry as of October 17, 2014. Results Aneurysm occurred in 200 patients (21.7{\%}) and dissection in 237 patients (25.7{\%}); in total, 384 patients (41.7{\%}) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were younger at presentation (48.4 vs. 53.5 years of age, respectively; p < 0.0001) and experienced more neurological symptoms and other end-organ ischemic events than those without dissection. One-third of aneurysm patients (63 of 200) underwent therapeutic intervention for aneurysm repair. Conclusions Patients with FMD have a high prevalence of aneurysm and/or dissection prior to or at the time of FMD diagnosis. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.",
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T1 - Dissection and Aneurysm in Patients With Fibromuscular Dysplasia

T2 - Findings From the U.S. Registry for FMD

AU - Kadian-Dodov, Daniella

AU - Gornik, Heather L.

AU - Gu, Xiaokui

AU - Froehlich, James

AU - Bacharach, J. Michael

AU - Chi, Yung-wei

AU - Gray, Bruce H.

AU - Jaff, Michael R.

AU - Kim, Esther S H

AU - Mace, Pamela

AU - Sharma, Aditya

AU - Kline-Rogers, Eva

AU - White, Christopher

AU - Olin, Jeffrey W.

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N2 - Background Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. Objectives This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without. Methods The U.S. Registry for FMD involves 12 clinical centers. This analysis included clinical history, diagnostic, and therapeutic procedure results for 921 FMD patients enrolled in the registry as of October 17, 2014. Results Aneurysm occurred in 200 patients (21.7%) and dissection in 237 patients (25.7%); in total, 384 patients (41.7%) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were younger at presentation (48.4 vs. 53.5 years of age, respectively; p < 0.0001) and experienced more neurological symptoms and other end-organ ischemic events than those without dissection. One-third of aneurysm patients (63 of 200) underwent therapeutic intervention for aneurysm repair. Conclusions Patients with FMD have a high prevalence of aneurysm and/or dissection prior to or at the time of FMD diagnosis. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.

AB - Background Fibromuscular dysplasia (FMD) is a noninflammatory arterial disease that predominantly affects women. The arterial manifestations may include beading, stenosis, aneurysm, dissection, or tortuosity. Objectives This study compared the frequency, location, and outcomes of FMD patients with aneurysm and/or dissection to those of patients without. Methods The U.S. Registry for FMD involves 12 clinical centers. This analysis included clinical history, diagnostic, and therapeutic procedure results for 921 FMD patients enrolled in the registry as of October 17, 2014. Results Aneurysm occurred in 200 patients (21.7%) and dissection in 237 patients (25.7%); in total, 384 patients (41.7%) had an aneurysm and/or a dissection by the time of FMD diagnosis. The extracranial carotid, renal, and intracranial arteries were the most common sites of aneurysm; dissection most often occurred in the extracranial carotid, vertebral, renal, and coronary arteries. FMD patients with dissection were younger at presentation (48.4 vs. 53.5 years of age, respectively; p < 0.0001) and experienced more neurological symptoms and other end-organ ischemic events than those without dissection. One-third of aneurysm patients (63 of 200) underwent therapeutic intervention for aneurysm repair. Conclusions Patients with FMD have a high prevalence of aneurysm and/or dissection prior to or at the time of FMD diagnosis. Patients with dissection were more likely to experience ischemic events, and a significant number of patients with dissection or aneurysm underwent therapeutic procedures for these vascular events. Because of the high prevalence and associated morbidity in patients with FMD who have an aneurysm and/or dissection, it is recommended that every patient with FMD undergo one-time cross-sectional imaging from head to pelvis with computed tomographic angiography or magnetic resonance angiography.

KW - angiography

KW - beading

KW - stenosis

KW - tortuosity

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