Abstract 211: Fibromuscular Dysplasia Causing Upper Extremity Acute Limb Ischemia

Abstract

Fibromuscular dysplasia (FMD) is a non-atherosclerotic arterial disease that affects mainly the renal and cervical arteries. It can also affect peripheral arteries leading to acute or chronic ischemia of the limbs. We present a rare case of FMD causing acute limb ischemia. Case Presentation: A 45-year-old male presented with acute onset pain and coldness in his left upper extremity, associated with numbness and tingling sensation in his left hand. He denied any history of trauma or recent surgery. His medical history was significant for hypertension. He was a non-smoker and denied any use of illicit drugs. On exam, his left hand was pale, cold, with absent distal pulses. The capillary refill time was prolonged, and the skin was mottled. There was tenderness in the hand muscles with no signs of compartment syndrome. Rest of the exam was normal. A diagnosis of acute limb ischemia was made, and the patient was urgently taken to the cath lab. Angiogram showed string and beads pattern of the radial artery with distal occlusion suggestive of FMD. Balloon angioplasty of the radial artery failed to improve blood flow. He subsequently underwent radial artery bypass using autologous vein graft with restoration of blood flow. Renal and carotid arteries were unaffected on CTA. Discussion: Fibromuscular dysplasia is a non-atherosclerotic, non-inflammatory disease that affects medium to small sized arteries. It is characterized by hyperplasia and fibrosis within the arterial wall. The exact etiology of FMD is unknown, and it is believed to be multifactorial. Renal artery FMD may present with renovascular hypertension, cervical artery involvement may present with headache, tinnitus, and vertigo. Patients with peripheral artery involvement may present with intermittent claudication, acute limb ischemia, or limb loss. CTA, MRA, or conventional angiography are diagnostic. In patients with acute limb ischemia, emergent intervention with thrombectomy, embolectomy, or bypass surgery may be necessary. Anti platelets and anticoagulants are also used. Conclusion: FMD is a rare disease that can present with a variety of clinical manifestations, including acute limb ischemia. Prompt diagnosis and treatment are essential to prevent limb loss and other serious complications.