Aortic findings, predominantly presenting as thoracic ectasia or aneurysm, were identified in 10% of patients with multifocal FMD and complete aortic imaging seen at a single specialised referral centre.
Aortic involvement was identified in 10.0% of patients with multifocal FMD who had complete aortic cross-sectional imaging.
The most common aortic finding was ectasia, followed by aneurysms, congenital anomalies, and acute aortic syndromes.
All aortic aneurysms and ectasias were located in the proximal thoracic aorta.
The most frequent congenital aortic anomaly identified was aberrant right subclavian artery.
Among patients with aortic involvement, genetic testing for aortopathies was uniformly negative.
Male sex and presence of non-aortic arterial aneurysms were more common among patients with aortic involvement compared to those without.
The findings support recommendations for head-to-pelvis imaging in patients with FMD.
Fibromuscular dysplasia (FMD) is a disease affecting medium-sized blood vessels that is not caused by cholesterol buildup. It primarily affects women and can cause beading, narrowing, ballooning (aneurysms), or tearing of arteries. This study looked at whether FMD also affects the aorta — the body's largest blood vessel — by reviewing medical records and imaging from 360 FMD patients seen at a specialized center over about five years. Researchers found that 1 in 10 patients had some form of aortic abnormality, most commonly mild enlargement (ectasia) or aneurysm of the upper portion of the aorta near the heart. A small number had congenital (present from birth) variations in aortic anatomy, and fewer than 1% had serious acute aortic events. This research suggests that aortic involvement in FMD is more common than previously recognized and tends to occur in the thoracic (chest) region rather than the abdominal region. Notably, genetic testing for known aortic diseases came back negative in all patients who were tested, suggesting the aortic changes seen in FMD patients may be part of the underlying FMD disease process rather than a separate inherited condition. Male patients and those with aneurysms in other arteries were more likely to have aortic involvement. These findings have practical implications for how FMD patients are monitored. The study supports current recommendations that FMD patients receive imaging that covers the entire body from head to pelvis, so that aortic abnormalities are not missed. The authors also call for more research into the genetic and systemic nature of FMD, as the reasons why some patients develop aortic changes remain unclear.
Ji K, Dejanovic D, Murphy J, Gornik H. (2026). Prevalence of aortic findings among patients with multifocal fibromuscular dysplasia (FMD) seen at a specialised referral centre.. Open heart. https://doi.org/10.1136/openhrt-2026-004253