Spotlight On: Fibromuscular Dysplasia (FMD)

What is fibromuscular dysplasia?

Alan Matsumoto, MD, is one of several FMD experts at UVA. While some doctors are not familiar with FMD and often overlook it, Matsumoto and his colleagues know it well. This month, he shares his expertise about this vascular condition that disproportionately affects younger women. 

Q. What is FMD?

A. With FMD, or fibromuscular dysplasia, there is an abnormal development or growth of cells in the walls of arteries, causing the vessels to narrow or bulge. Tell-tale signs of the disease are an artery that looks like a string of beads and a roaring sound (or bruit) that can be heard with a stethoscope. 

It most often affects the renal and carotid arteries (that supply blood to the kidneys and brain respectively), but almost any artery can be involved. The causes are unknown, but mechanical and hormonal factors are thought to play a role. There also may be a genetic component as it can run in families. FMD can lead to kidney failure, stroke and brain aneurysms. 

Q. How many people are affected by FMD?

A. Although considered a rare disease, it is possible up to 10 million Americans have FMD, although many never experience any symptoms. About 85 percent of known cases have affected women under 50 and girls, although men and boys can have it too. 

Q. What are the symptoms of FMD?

A. Hypertension and stroke are the more common symptoms of FMD, but someone can also experience intestinal symptoms, a choking sensation and even anxiety like when you’ve had too much coffee. Symptoms can also include dizziness, chronic headache, ringing in the ears, weakness or numbness in the face, neck pain and temporary blurring or loss of vision. Still others with FMD have no symptoms. 

Q. How is FMD detected and controlled?

A. FMD can be detected using a number of diagnostic procedures including ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) and angiography. With angiography, a dye is inserted into a patient's arteries through a catheter and then an X-ray is taken to show how blood flows through the arteries and whether any arteries are narrowed or blocked. Often, FMD requires angiography for a thorough diagnosis. 

Once FMD is uncovered, symptoms can be controlled with blood pressure medication and regular angioplasties. In this procedure, a surgeon inserts a catheter with a balloon on its tip and runs it to the area of the artery that is narrowed. The balloon is inflated, opening up the artery. Some FMD cases require surgery based on factors such as its location. 

Q. What is UVA’s experience with treating FMD?

A. UVA has a long history of treating FMD. In fact, in 1978 a UVA interventional radiologist, Charles J. Tegtmeyer, M.D., changed the course of medical history when he performed the nation’s first balloon angioplasty — a procedure that has either improved or saved the lives of countless people with FMD and other vascular conditions. (Dr. Tegtmeyer died in 1996.) Today, I am proud to be part of UVA’s Vascular Center, which includes a team of physicians, radiologists and other health professionals who continue to be leaders in vascular care.