Fibromuscular dysplasia in living renal donors: Still a challenge to computed tomographic angiography

Abstract 

Background

Computed tomographic angiography has become the standard evaluating method of potential living renal donors in most centers. Although incidence of fibromuscular dysplasia is low (3.5–6%), this pathology may be relevant for success of renal transplantation. The incidence of FMD in our population of LRD and reliability of CTA for detecting vascular pathology were the aims of this study.

Materials and methods

101 living renal donors, examined between 7/2004 and 9/2008 by CTA, were included in a retrospective evaluation. The examinations were carried out using a 64 Multi-detector CT (Siemens Medical Solutions, Erlangen). The presence or absence of the characteristic signs of fibromuscular dysplasia, as “string-of-beads” appearance, focal stenosis or aneurysms, were assessed and graded from mild (=1) to severe (=3). Furthermore, vascular anatomy and arterial stenosis were investigated in this study. Retrospective analysis of CTA and ultrasound were compared with operative and histological reports.

Results

Four cases of fibromuscular dysplasia (incidence 3.9%) in 101 renal donors were diagnosed by transplanting surgeons and histopathology, respectively. Three cases could be detected by CTA. In one donor even retrospective analysis of CTA was negative. Ten accessory arteries, 14 venous anomalies and 12 renal arteries stenosis due to atherosclerosis were diagnosed by CTA and could be confirmed by the operative report.

Conclusion

CTA is sufficient for detection of hemodynamic relevant stenosis and vascular anatomy. Only one patient with a mild form of FMD was under estimated. Therefore, if the CTA shows slightest irregularities which are not typical for atherosclerotic lesions, further diagnostic work up by DSA might still be necessary.

Keywords: Computed tomographic angiography, Living renal donors, Fibromuscular dysplasia