In Reply to: Re: Case 0298_01 -- Hypertension in a 40-year-old woman posted by Jeet Sandhu on February 06, 1998 at 17:38:38:
I did an angiogram a few years ago on a 60 year old woman with hypertension refractory to a three medicine regimen that showed the typical beaded appearance of medial fibroplasia in the right renal artery with an associated large AV fistula. The right kidney was quite small suggesting long-standing steal with atrophy. Although I had no proof, I assummed that the AV fistula resulted from spontaneous rupture of an FMD-associated aneurysm into the right renal vein. She had never undergone a biopsy and biochemical workup for a pheo was negative. I offered to embolize the right renal artery at the time, but the (HMO, salaried) vascular surgeon preferred nephrectomy.