Fibromuscular Dysplasia Treatment and Therapies

The best course of treatment for fibromuscular dysplasia (FMD) is different for each patient. At the University Hospitals FMD Program, our multidisciplinary team of fibromuscular dysplasia specialists works closely with patients to create treatment plans that are customized to the individual. For many patients, the FMD treatment plan is focused on medical therapy (for blood pressure control and to prevent blood clots) managing symptoms and monitoring the disease. Some patients with FMD will need a vascular procedure, such as a kidney artery angioplasty or treatment of an aneurysm. Your FMD physician may also talk with you about lifestyle changes that may help manage your FMD symptoms.

Medical Therapies for Fibromuscular Dysplasia

Medical therapies for patients with FMD are important for management of FMD-related symptoms, control of blood pressure, and to prevent complications. In order to prevent blood clot formation, your physician may prescribe an antiplatelet medications, such as aspirin or clopidogrel. Anticlotting medication is thought to help reduce the risk of FMD complications such as stroke or transient ischemic attack (mini stroke) for patients with carotid and/or vertebral artery FMD.

For patients experiencing high blood pressure due to renal artery FMD, your physician will likely prescribe medications. These medications may include, but are not limited to, diuretics (water pills), ACE-inhibitors or angiotensin receptor blockers, beta-blockers, and calcium channel blockers.

Lifestyle changes may also be recommended to manage high blood pressure, such as reducing the amount of sodium (salt) in your diet, maintaining a healthy body weight, and aerobic exercise.

Monitoring Fibromuscular Dysplasia

In general, it is thought that FMD is not a rapidly progressive disease. This means that for most patients, the disease and its symptoms do not tend to worsen over time. Rarely, a patient may develop worsening or new symptoms, and there is a risk of developing a dissection (tear) of an artery over time.

Regularly scheduled follow-up visits with a healthcare provider familiar with FMD are typically recommended. Follow-up can be as frequent as every three to six months – especially initially – or less frequent, such as every year.

During a follow-up visit at University Hospitals, our team will assess your FMD-related symptoms, your blood pressure, and how you are doing with your medications. In most cases, vascular imaging tests are done to monitor areas of the body that are affected by FMD. As part of standard practice for patients in the UH FMD Program, a screen of all artery vessels from head to pelvis is performed with specialized imaging studies to make sure there are no aneurysms.

Blood work may also be done periodically to monitor things such as kidney function, electrolytes, and blood counts.

These follow-up visits are also a chance to check in with your FMD physician regarding any new information that has been learned about FMD since your last visit and to answer your questions.

Managing Fibromuscular Dysplasia-Related Symptoms

Two of the most common symptoms affecting patients with FMD are headaches (both migraine and non-migraine type) and pulsatile tinnitus (swooshing sound in ears). For many patients, these symptoms can be managed to improve quality of life. In managing headaches, the severity and frequency of symptoms are first assessed. Your doctor may review some strategies to prevent headaches, such as natural over-the-counter supplements, dietary modifications to avoid triggering headaches, prescription medications to prevent or reduce the frequency of headache, and treatments to stop headaches if they occur. Your FMD provider may also refer you to a headache specialist if your headaches are very frequent and severe to further discuss other treatment options.

There are a number of approaches to managing pulsatile tinnitus, depending on the severity of your symptoms and how much they affect your quality of life and sleep. Your FMD provider may discuss options such as relaxation techniques (e.g., meditation, breathing exercises), cognitive behavioral therapy, and sound therapy (such as white noise devices). For many patients, the reassurance that the pulsatile tinnitus is not a dangerous symptom can help. Your physician may also discuss referral to an audiology (hearing specialists) or ENT provider for further evaluation.

Vascular Procedures for Fibromuscular Dysplasia

Depending on the location of FMD and the type and severity of FMD symptoms, certain vascular procedures may be recommended by your physician.

The most common vascular procedure recommended for patients with FMD is balloon angioplasty of the renal arteries for treating hypertension caused by narrowing of the kidney arteries. An angioplasty is used to widen narrowed arteries and may be recommend for patients that have new or recent onset of high blood pressure or uncontrolled high blood pressure due to renal FMD.

Less commonly, angioplasty may be recommended for treatment of symptoms related to FMD in other arteries of the body. In rare cases, other vascular procedures, such as surgical bypass, may be needed to treat narrowing of the arteries that cannot be effectively treated with angioplasty techniques.

In addition to treatment of artery narrowing due to FMD, some patients with FMD may have aneurysms that require treatment to prevent complications from aneurysm rupture. About one in four patients with FMD have an aneurysm in the body, with the most common sites being the brain (cerebral) arteries or the arteries of the abdomen (renal or other abdominal arteries). There are a number of different techniques that can be used to treat aneurysms. Some FMD-related aneurysms can be treated with less invasive procedures, such as coiling and/or stenting, but in some cases, open surgery is required, such as clipping of certain brain aneurysms. Some artery dissections (tears) may also require a vascular procedure, such as stenting, in addition to medication, for effective treatment.

Lifestyle Modifications for Living with Fibromuscular Dysplasia

Though FMD is a vascular disease that does not have a cure, most patients with FMD can continue to lead high quality, highly productive lives.

You should talk to your FMD doctor about potential modifications to your lifestyle in order the manage FMD. These may include:

• Moderate aerobic exercise, such as walking or jogging, cycling, or aerobic dance
• Eating a well-balanced diet, rich in fruits and vegetables for overall cardiovascular health (though there is no evidence that FMD is related to diet)
• Low sodium diet for FMD patient with high blood pressure
• Quit smoking; recent studies have shown that patients with FMD who smoke have more complications

Depending on the specifics of your case, your FMD provider may recommend against certain activities that could potentially increase the risk of an artery dissection, such as:

• Lifting heavy objects
• Contact sports
• Chiropractic neck adjustments
• Certain thrill sports and amusement park rides

You should discuss your activities and hobbies with your FMD provider.

Fibromuscular Dysplasia & Pregnancy

For women with FMD, the decision to become pregnant must be made after careful evaluation and thoughtful discussion with your FMD physician. Certain patients with FMD may be at higher risk during and after pregnancy, especially those who have had a prior artery dissection or who have an aneurysm.

Fibromuscular Dysplasia & Menopause

For women who are diagnosed with FMD later in life, managing symptoms of menopause and considering the safety of hormone replacement therapy also requires careful consideration and discussion with your FMD provider and other members of your healthcare team, such as you primary care physician and gynecologist.