Systematic and Multidisciplinary Evaluation of Fibromuscular Dysplasia Patients Reveals High Prevalence of Previously Undetected Fibromuscular Dysplasia Lesions and Affects Clinical Decisions
Ewa Warchoł-Celińska, Aleksander Prejbisz, Piotr Dobrowolski, Anna Klisiewicz, Jacek Kądziela, Elżbieta Florczak, Ilona Michałowska, Katarzyna Jóźwik−Plebanek, Marek Kabat, Paweł Kwiatek, Sławomir Nazarewski, Krzysztof Madej, Olgierd Rowiński, Łukasz Światłowski, Mariola Pęczkowska, K. Hanuš, Paulina Talarowska, Mikołaj Smólski, Katarzyna Kowalczyk, Iwona Kurkowska‐Jastrzębska, Ludomir Stefańczyk, Andrzej Więcek, Krystyna Widecka, Andrzej Tykarski, Łukasz Stryczyński, Mieczysław Litwin, Piotr Hoffmań, Adam Witkowski, M. Szczerbo-Trojanowska, Magdalena Januszewicz, Andrzej Januszewicz
Abstract
Fibromuscular dysplasia (FMD), regarded as a generalized vascular disease, may affect all vascular beds and may result in arterial stenosis, occlusion, aneurysm, or dissection. It has been proposed to systematically evaluate all vascular beds in patients with FMD, regardless of initial FMD involvement. However, the impact of this approach on clinical decisions and on management is unknown. Within the prospective ARCADIA-POL study (Assessment of Renal and Cervical Artery Dysplasia-Poland), we evaluated 232 patients with FMD lesions confirmed in at least one vascular bed, out of 343 patients included in the registry. All patients underwent a detailed clinical evaluation including computed tomography angiography of intracranial and cervical arteries, as well as computed tomography angiography of the abdominal aorta, its branches, and upper and lower extremity arteries. In the study group, FMD lesions were most frequently found in renal arteries (87.5%). FMD was also found in cerebrovascular (24.6%), mesenteric (13.8%), and upper (3.0%) and lower extremity (9.9 %) arteries. Newly diagnosed FMD lesions were found in 34.1% of the patients, and previously undetected vascular complications were found in 25% of the patients. Among all FMD patients included in the study, one out of every 4 evaluated patients qualified for interventional treatment due to newly diagnosed FMD lesions or vascular complications. The ARCADIA-POL study shows for the first time that the systematic and multidisciplinary evaluation of patients with FMD based on a whole-body computed tomography angiography scan has an impact on their clinical management. This proved the necessity of the systematic evaluation of all vascular beds in patients with FMD, regardless of initial FMD involvement.