Standing Arterial Waves Is NOT Fibromuscular Dysplasia

We report 2 cases in which patients were misdiagnosed as having fibromuscular dysplasia (FMD) due to the finding of standing arterial waves on lower extremity angiography. Patient 1A 40-year-old woman with a 3-year history of chronic fatigue, as well as bilateral exertional upper and lower extremity pain, was referred to our center for suspected FMD due to the finding of diffuse beading noted in multiple arterial segments on lower extremity angiography performed at another institution (Figure 1). Her vascular examination was unremarkable except for nonpalpable pulses at the anterior tibial and dorsalis pedis arterial bilaterally, which likely represented an anatomic variant. Ankle-brachial indices were normal at rest and after treadmill exercise was terminated due to bilateral leg pain. Plethysmographic tracings of the toes were dampened and toe-brachial indices were mildly reduced, findings that were attributed to mild vasospasm. Magnetic resonance imaging performed at the outside facility showed normal renal arteries. Repeat arteriography demonstrated no significant stenoses or beading pattern in the …