To date there is no cure for FMD. However, FMD can be adequately managed with the objective of alleviating symptoms and preventing complications.
Medications such as antihypertensive drugs may be prescribed in the case of renal artery FMD causing hypertension. Blood thinners, in the form of low dose aspirin may also be recommended, particularly in the case of multifocal FMD, or FMD of the cerebrovascular (head and neck) arteries.
Many FMD patients suffer from headaches, often migraines (which can be experienced as throbbing or pulsating) that may be treated by painkillers as needed, or an anti-migraine treatment. Certain antihypertensives such as beta blockers may prevent headache. Vasoconstrictors such as Ergotamine and Triptans are in principle contraindicated in patients with FMD.
Given the possible role of tobacco in the progression of FMD, smoking cessation is strongly recommended.
In case of severe FMD-related renal artery stenosis at the origin of hypertension, or other symptoms linked to reduced blood flow to the kidney, a percutaneous angioplasty may be proposed, to dilate the artery with a balloon catheter and reopen the stenosis. This is usually carried out on the occasion of the angiography that enables confirmation of the diagnosis. A narrow tube (catheter) is inserted into the artery, most often via the femoral artery (groin), then a balloon is inflated within the artery to reopen the narrowing (stenosis) to improve the blood flow. Stenting is usually not necessary, and in fact is not recommended because cases of stent blockage by thrombosis (blood clots) and stent fracture have been reported. A stent may nevertheless be necessary in the un-frequent case of a tear in the artery (dissection) or in other specific situations. After an angioplasty, there should be at least a 24 hr monitoring period in hospital. In the case of associated aneurysms, FMD in small arterial branches or repeated failed angioplasties, a classical surgical procedure may be necessary.
In the case of cerebral aneurysms, the options proposed may include regular surveillance by imaging, or endovascular treatment by coiling or stenting, or even classic open surgery. The management depends on the risk factors and age of the patient, as well as the size and location of the aneurysm/s.
Generally, the treatment proposed for FMD will depend on the symptoms and clinical manifestations of the disease, as well as the severity, localization and extent of arterial lesions. The treatment/ management should be discussed with a specialist with expertise in FMD, preferably within a multidisciplinary team.