Cystic adventitial disease of the popliteal artery. A case report and review of the literature

Cystic adventitial disease is a rare form of non-atherosclerotic stenosis and one of the main causes of claudication in young and middle-aged men. Approximately 200 case reports are available in the literature to date. It is generally located in the popliteal artery, although it may be found in other arteries and even in veins. The aetiology is still unclear: most authors believe that the cyst may originate from a synovial ganglion close to the adjacent hip joint capsule. Patients affected by adventitial cystic degeneration are often young male non-smokers with intermittent calf claudication. The treatment of choice is surgical removal of the cyst or reconstruction with autologous vein or synthetic graft interposition. Percutaneous US-guided cystic aspiration is a recent easy and safe alternative method for treating the disease but may result in local recurrence. We report the case of a 51-year-old male patient with clinically intermittent claudication of the right leg. The arteriogram showed complete occlusion of the right proximal popliteal artery and no evidence of atherosclerotic disease in other vessels. The diagnosis was made at the time of surgery. Surgical exploration revealed a gelatinous material involving the popliteal artery. It was excised and evacuated and a segment of greater saphenous vein interposed. Ultrasound examination 12 months later showed graft patency and absence of local recurrence.     

Cystic adventitial disease of the popliteal artery. Report of 2 cases and review of the literature

Two cases of cystic adventitial degeneration of the popliteal artery are reported and aetiopathogenetic theories, diagnosis and treatment discussed. One of the cases presented is of special interest because, at surgery, it was possible to observe the relationships of the artery with the articular capsule of the knee through a genicular vessel which, when sectioned, showed an exit of mucinous material the equivalent of that contained in the vasal cyst. This observation gives even more credence to the so-called "articular" aetiopathogenetic theory. The two cases were treated surgically with resection of that segment of the artery and contralateral saphenous vein graft giving an excellent short-term and long-term result and protecting from recurrences.     

Cystic adventitial degeneration of the popliteal artery. Report of a case.

A case of cystic adventitial degeneration of the popliteal artery is described. This is an unusual cause of intermittent claudication, but the diagnosis should be suspected in young persons, especially men, where the arteriogram shows a stenosis due to compression and arteriosclerotic changes are not demonstrable. A brief review of the literature on the condition, diagnosis, and treatment is given.     

Cystic adventitial disease of the popliteal artery

Cystic adventitial disease of the popliteal artery has been recognized as a cause of arterial stenosis and calf claudication for 30 years. It is reported infrequently and its etiology remains unknown. In addition, a peculiar geographic distribution of the reported cases of this disorder has been noted, with a majority of cases from Europe and Australasia. The authors report here a case from South Carolina in which a fibrous band may have contributed to compression during exercise. Noninvasive studies and angiographic studies were negative before exercise and positive after exercise. Current ideas of diagnosis, surgical treatment and possible etiology are presented.     

Cystic adventitial degeneration of the popliteal artery

Cystic adventitial degeneration (CAD) of the popliteal artery is a rare, but well-recognized, disorder leading to claudication. Usually, surgical treatment is indicated. So far, <400 patients have been described. We report on a series of three patients with CAD. Because we observed local recurrence of CAD after local resection, we conclude that 360° resection and venous interposition is preferable for a favorable outcome. Furthermore, we review etiology, pathology, and different surgical treatment approaches.     

Cystic adventitial disease of the popliteal artery: a report of two cases and a review of the literature

Cystic adventitial disease is a rare condition affecting the wall of certain major arteries. The case histories of two patients presenting to the Royal North Shore Hospital are reviewed. Both patients were young men who presented with unilateral incapacitating calf claudication of sudden onset. Lower limb arteriography on each affected leg revealed a peculiar irregularity of the popliteal artery. Each patient had the popliteal artery explored and similar findings were revealed viz: an extensive cyclic lesion occupying the adventitial layer of the popliteal artery. The cysts were found to contain mucoid material. It was not necessary to enter the arterial lumen in either case. As far as can be established both patients have remained asymptomatic after the simple procedure of evacuating mucoid material from the cysts.     

Cystic adventitial disease: a case report and literature review

Cystic adventitial disease (CAD) is a rare non-atherosclerotic cause of peripheral vascular disease (PVD). We describe a 54-year-old man who presented with calf claudication and catheter angiography showed the typical scallop appearances of CAD. Surgery involved resection of the diseased segment with a femoral popliteal venous bypass graft. A literature review revealed the different theories for pathogenesis, the investigation of choice being catheter angiography and the treatment excision with bypass grafting.     

Cystic adventitial disease of the popliteal artery: report of two cases

Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disorder in which a mucin-containing cyst develops in the adventitial layer of the artery. We report two such cases, each of which was treated differently. The first case was of a 49-year-old man, treated by excision of the involved arterial segment and interposition of an autologous saphenous vein graft. The second case was of a 36-year-old man, treated by local excision of the affected arterial segment and interposition with prosthetic bypass grafting. Both patients presented with rapidly progressing intermittent claudication of the lower extremities, but without remarkable evidence of atherosclerotic disease. Physical examination revealed diminished or absent popliteal, posterior tibial and dorsalis pedis pulses in the lower extremities. Color Doppler ultrasound of the popliteal artery revealed hypoechoic cystic lesions surrounding the vessel, and popliteal arterial stenosis, in both patients. Surgery resulted in immediate improvement of the arterial pulse distal to the lesion. Both patients recovered uneventfully. Thus, resection of the involved artery segment and interposition bypass grafting, using either patient or prosthetic veins, offers favorable results for CAD of the popliteal artery.     

Cystic adventitial disease of the iliofemoral artery: case reports and a short review

Cystic adventitial disease is a rare disease affecting mainly young males. We describe two patients with this disease affecting the iliofemoral artery. These reports reemphasize the importance of keeping cystic adventitial disease as a differential diagnosis in young patients who present with leg ischemia.     

Cystic adventitial disease of the popliteal artery: an argument for the developmental theory

Cystic adventitial disease is a rare non-atheromatous cause of popliteal artery disease. We report a case of a 54-year-old patient with claudication of the right calf caused by cystic adventitial disease. Intra-operatively, a communication between the adventitia and the knee joint was identified. Connections between the adventitial cyst and the nearby joint have been reported in the literature that support the developmental theory. This theory suggests that cystic adventitial disease is a developmental manifestation of mucin-secreting cells derived from the mesenchyme of the adjacent joint. This case is the first, to our knowledge, in which a communication between joint and adventitia has been clearly documented by operative findings.     

Cystic adventitial disease of the popliteal artery and of other stem vessels in the extremities

Two hundred and thirty-four cases of cystic adventitial disease were collected from over two hundred world literatures and were classified into two groups: first, typical cystic adventitial disease of the popliteal artery, and second, that of the stem vessels in extremities other than the popliteal artery. The nomenclatures, clinical and pathological features, and etiology were reviewed. From the etiological point of view, the group in which the cyst was connected with joint capsule was identified as the joint group. All cases reported are listed in the two tables except those cases listed already in Flanigan's table.     

Cystic adventitial disease of the popliteal artery and of other stem vessels in the extremities

Two hundred and thirty-four cases of cystic adventitial disease were collected from over two hundred world literatures and were classified into two groups: first, typical cystic adventitial disease of the popliteal artery, and second, that of the stem vessels in extremities other than the popliteal artery. The nomenclatures, clinical and pathological features, and etiology were reviewed. From the etiological point of view, the group in which the cyst was connected with joint capsule was identified as the joint group. All cases reported are listed in the two tables except those cases listed already in Flanigan's table.