BACKGROUND: Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic, degenerative vascular disease that most frequently affects renal and carotid arteries in women aged 30–50 years, and rarely complicating arteries of the lower limbs.

CASE REPORT: A 60-year-old woman was admitted with intermittent claudication of both legs. We performed pelvic and bilateral lower-extremities angiography, which revealed that the bilateral external iliac arteries (EIAs) had the ‘string of beads’ appearance with a diagnosis of FMD. Endovascular therapy (EVT) was performed for the bilateral EIAs. Optical coherence tomography (OCT) images showed thickening and thinning of the middle layer, while three-dimensional OCT images showed a ‘haustra coli’-like appearance. After successful balloon angioplasty, claudication completely disappeared.

CONCLUSIONS: We report a rare case of EVT successfully performed for FMD of the bilateral EIAs. Our findings suggest that OCT may provide unique diagnostic clues in FMD patients.

Keywords: Fibromuscular Dysplasia - therapy, Angioplasty, Balloon, Iliac Artery, Tomography, Optical Coherence