Renal artery aneurysm rupture, axillary artery pseudoaneurysm and catastrophic intraperitoneal hemorrhage caused by fibromuscular dysplasia with the involvement of multiple arterial beds

Haihua Zhou¹Shi Sheng¹Yun You¹Jian Wang^2*

• ¹Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
• ²Department of General Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

We reported an unusual case of fibromuscular dysplasia (FMD) with multisite involvement into the intracranial, carotid, vertebral, internal mammary, visceral, renal, iliac, axillary and upper extremity arteries in a 30-year-old woman who encounters renal artery aneurysm rupture and expending axillary artery pseudoaneurysm that happen spontaneously. The diagnosis of the multifocal FMD was based mostly on the classical strings-of-beads angiographic appearance of upper extremity, visceral, vertebral, carotid, internal mammary arteries. A coil embolization procedure was successfully performed to treat ruptured renal aneurysm. Open surgical repair of a pseudoaneurysm was uneventfully achieved by direct arterial suture. Unfortunately, the patient suffered from recurrent intraperitoneal hemorrhage, declined any endovascular interventional or open surgical procedures, and eventually was died from hemorrhagic shock and multiple organ failure. To our knowledge, this is the first case in the literature describing a rare and severe FMD involving multiple arterial beds in the regions of head, neck, chest, abdomen and pelvis, which adversely cause renal artery aneurysm rupture, axillary artery pseudoaneurysm and catastrophic intraperitoneal hemorrhage.