Case Report: Renal artery aneurysm rupture, axillary artery pseudoaneurysm, and catastrophic intraperitoneal hemorrhage caused by fibromuscular dysplasia with the involvement of multiple arterial beds

We report an unusual case of fibromuscular dysplasia (FMD) with multisite involvement into the intracranial, carotid, vertebral, internal mammary, visceral, renal, iliac, axillary, and upper extremity arteries in a 30-year-old woman. The patient presented with a spontaneous rupture of a renal artery aneurysm and an expanding axillary artery pseudoaneurysm. The diagnosis of the multifocal FMD was based mostly on the classical strings-of-beads angiographic appearance of the upper extremity, visceral, vertebral, carotid, and internal mammary arteries. A coil embolization procedure was successfully performed to treat the ruptured renal aneurysm. In addition, open surgical repair of the pseudoaneurysm was uneventfully achieved using direct arterial suture. Unfortunately, the patient suffered from recurrent intraperitoneal hemorrhage, declined further endovascular interventional or open surgical procedures, and eventually died from hemorrhagic shock and multiple organ failure. To our knowledge, this is the first case in the literature describing a rare and severe FMD involving multiple arterial beds in the regions of the head, neck, chest, abdomen, and pelvis, which adversely caused renal artery aneurysm rupture, axillary artery pseudoaneurysm, and catastrophic intraperitoneal hemorrhage.