The interventional therapy for axillary stenosis with fibromuscular dysplasia of renal artery
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CASE REPORT
The interventional therapy for axillary stenosis with fibromuscular dysplasia of renal artery Akihiro Higashimori • Yoshiaki Yokoi
Received: 23 May 2012 / Accepted: 1 October 2012 / Published online: 13 October 2012 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2012
Abstract A 55-year-old female, presented with a 1-year history of paresthesia and intermittent weakness of her left hand. She had hypertension, and the angiographic findings revealed a ‘‘string of beads’’ appearance in the right renal artery. She underwent balloon angioplasty for left axillary artery stenosis, but it was complicated by dissection. Stenting for axillary artery established TIMI 3 flow to the brachial artery. This case was a result of noninflammatory and probably nonatherosclerotic disease, and the findings in this cases is consistent with those of fibromuscular dysplasia affecting the axillary arterial segment. In summary, we present details of a case presenting with brachial ischemia caused by axillary artery stenosis. We also describe the meticulous investigation required for treating this segmental arterial disease. Keywords Peripheral vascular disease Stent Balloon angioplasty FMD
Introduction Upper extremity ischemia is rare and secondary to fibromuscular dysplasia is very rare [1]. Fibromuscular dysplasia is a well-recognized clinical entity, but it typically affects the renal and carotid arteries. Here we present a case of brachial ischemia caused by axillary arterial stenosis with renal fibromuscular dysplasia (FMD).
A. Higashimori (&) Y. Yokoi Department of Cardiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori, Kishiwada, Osaka 596-8522, Japan e-mail: [email protected]
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Case A 55-year-old female presented at our hospital with a 1-year history of paresthesia and intermittent weakness of her left hand. On physical examination, all pulses except that of the left radial and brachial arteries were normal. Pulsation of left radial and brachial arteries in this patient were weakly palpable. The patient has hypertension and has been administrated two antihypertensive medications, no other risk factors were identified and she had no history of trauma. Her blood pressure was 161/106 mmHg in her right arm and 144/79 mmHg in her left arm. Electrocardiography and echocardiography presented normal findings. Vascular ultrasound studies revealed a severe focal stenosis of the left axillary artery with a Peak systolic velocity (PSV) of 307 m/s (PSV ratio 5.4). Renal duplex echo showed that PSV of the right renal artery was 198 cm/s and renal aorta ratio was 3.41, suggesting right renal artery stenosis. Angiography was thus performed via a right femoral approach. The patient had a long history of hypertension, and because the renal duplex suggested right renal artery stenosis, selective right renal angiography was also performed. This renal angiography revealed a typical ‘‘string of beads’’ appearance in the mid section of the right renal artery (Fig. 1). However, no pressure
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