Surgical Treatment of Fibromuscular Disease of the Carotid Arteries

Abstract

FIBROMUSCULAR disease is a familiar cause of renovascular hypertension.^1,2It has represented the etiologic factor in 14% of our patients having arterial revascularization procedures for hypertension or renal failure. Surgical management of the renal lesion in a series of 155 cases has not been difficult because the process is usually confined to the main renal artery, and even when primary divisions are involved these may be readily exposed and managed with accepted angioplastic techniques. Similarly, less common extrarenal fibromuscular disease has been readily managed in the celiac, mesenteric, and iliac arteries. In contrast, however, fibromuscular disease of the internal carotid artery has presented a challenge to us in applying accepted techniques of arterial reconstruction. The surgical problem has been related to the usual extensive involvement of the extracranial portion of the internal carotid artery by the fibromuscular process. The process usually extends high in the neck to the