Isolated Iliac Artery Dissection Secondary to Fibromuscular Dysplasia

Abstract

Among the nonatherosclerotic vascular diseases leading to ischemic complications in young adults, fibromuscular dysplasia (FMD) is relatively common. Manifestations of this abnormality most frequently occur secondary to stenosis, aneurysm formation, or embolization of the renal or internal carotid arterial beds. Although 3 cases of external iliac artery dissection (2 with confirmed FMD) have been reported, no reports exist of isolated dissection of the common iliac artery in the absence of a more proximal aortic entry point. Three otherwise healthy men were diagnosed with acutely symptomatic isolated iliac artery dissection (2 common iliac, 1 external iliac). Two patients required arterial bypass grafting for the relief of ischemia; histologic examination demonstrated FMD. The third patient had early findings on arteriography of associated renal arterial FMD. Although a dissection of the common iliac artery was confirmed in this patient on imaging studies as well as arteriography, he manifested no ischemic symptoms or aneurysmal dilation and is being managed nonoperatively. The diagnosis of arterial dissection secondary to FMD should be strongly considered in the differential diagnosis of young patients with signs and symptoms of lower extremity ischemia. Noninvasive diagnostic modalities (computerized tomography [CT], magnetic resonance imaging [MRI], and duplex scans) will establish the diagnosis, but arteriography remains essential to delineate the extent of involvement. The associated finding of FMD in other vascular beds may help to confirm the diagnosis as well as contribute to the future management of these patients.