ISOLATED ILIAC ARTERY DISSECTION SECONDARY TO FIBROMUSCULAR DYSPLASIA- 3 CASES IN YOUNG-ADULTS

Among the nonatherosclerotic vascular diseases leading to-ischemic com plications in young adults, fibromuscular dysplasia (FMD) is relativel y common. Manifestations of this abnormality most frequently occur sec ondary to stenosis, aneurysm formation, or embolization of the renal o r internal carotid arterial beds. Although 3 cases of external iliac a rtery dissection (2 with confirmed FMD) have been reported, no reports exist of isolated dissection of the common iliac artery in the absenc e of a more proximal aortic entry point. Three otherwise healthy men w ere diagnosed with acutely symptomatic isolated iliac artery dissectio n (2 common iliac, 1 external iliac). Two patients required arterial b ypass grafting for the relief of ischemia; histologic examination demo nstrated FMD. The third patient had early findings on arteriography of associated renal arterial FMD. Although a dissection of the common il iac artery was confirmed in this patient on imaging studies as well as arteriography, he manifested no ischemic symptoms or aneurysmal dilat ion and is being managed nonoperatively. The diagnosis of arterial dis section secondary to FMD should be strongly considered in the differen tial diagnosis of young patients with signs and symptoms of lower extr emity ischemia. Noninvasive diagnostic modalities (computerized tomogr aphy [CT], magnetic resonance imaging [MRI], and duplex scans) will es tablish the diagnosis, but arteriography remains essential to delineat e the extent of involvement. The associated finding of FMD in other va scular beds may help to confirm the diagnosis as well as contribute to the future management of these patients.