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Potential Pitfalls of Renal Angiography: A Case of Atypical Fibromuscular Dysplasia

Division of Cardiology, the University of Rochester School of Medicine, Rochester, New York

James A. Sloand, MD

Division of Nephrology, the University of Rochester School of Medicine, Rochester, New York

Craig R. Narins, MD

Division of Cardiology, the University of Rochester School of Medicine, Rochester, New York, Division of Vascular Surgery, the University of Rochester School of Medicine, Rochester, New York, craig_narins{at}urmc.rochester.edu

Although angiography remains the gold standard for the diagnosis of renal artery stenosis, renovascular disease can at times present with unusual patterns that may be difficult to detect. The authors present a case in which an initial renal angiogram failed to identify the presence of severe disease involving both a main and accessory renal artery. Repeat angiography coupled with the use of adjunctive catheter-based techniques including translesional pressure gradient determination and intravascular ultrasound with virtual histology imaging revealed the presence of atypical fibromuscular dysplasia that was treated with good clinical results. The case highlights the importance of performing careful and complete renal angiography, including imaging of smaller accessory renal arteries, and describes several readily available catheter-based techniques that can be useful in elucidating the physiological significance and etiology of renal artery stenosis.

Key Words: renal artery stenosis • fibromuscular dysplasia • angiography

This version was published on January 1, 2009

Angiology, Vol. 59, No. 6, 753-756 (2009)
DOI: 10.1177/0003319707308726


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