Bilateral Adventitial Cystic Disease of the Popliteal Artery: A Case Report

M, William R. Ortiz; Lopera, Jorge E.; Giménez, Carlos; Restrepo, Carlos S.; Moncada, Rogelio; Castañeda-Zúñiga, Wilfrido R.

doi:10.1007/s00270-004-0300-5

Cited by 39 publications

(49 citation statements)

References 19 publications

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“…Finally, the developmental theory suggests that mucin is secreted by mucin-secreting mesenchymal cells from nearby joints that incorrectly migrated to the adventitia during embryogenesis. In some cases, connections of the cyst with the capsule of the adjacent joint were documented, supporting the latter theory (3,7,8).…”

Section: Discussionsupporting

confidence: 48%

“…CAD causes relatively sudden onset of claudication, and the symptoms may worsen with knee flexion. When there is communication of the cyst with the knee joint, exercise or repetitive trauma may cause rapid growth of the cyst, with accelerated progression of symptoms (1,3). Spontaneous rupture of the cyst is rare, but may result in relief of symptoms (5).…”

Section: Discussionmentioning

confidence: 99%

“…The disease usually affects the popliteal arteries (about 85% of the cases) and more rarely the common femoral, external iliac, radial, and ulnar arteries (2). A case of bilateral CAD of the popliteal artery has been reported (3). Cases involving veins also have been reported (4).…”

mentioning

confidence: 99%

“…CAD is characterized by a collection of a gelatinous material rich in mucoproteins and mucopolysaccharides, clear and colorless or yellowish, located between the adventitia and the middle layer of the vessel wall, compressing the lumen of the artery (3,5). Pathogenesis of this entity is unclear, but four theories have been proposed (3,6).…”

mentioning

confidence: 99%

“…Pathogenesis of this entity is unclear, but four theories have been proposed (3,6). The trauma theory suggests chronic degeneration by repetitive trauma.…”

mentioning

confidence: 99%

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Cystic adventitial disease of the popliteal artery

Michaelides

Pervana²,

Sotiridadis³

et al. 2009

Diagn Interv Radiol

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166C ystic adventitial disease (CAD) is a rare condition that usually affects the popliteal artery. It is most commonly found in young or middle-aged men, usually non-smokers, with intermittent claudication. The pathogenesis of the disease is unclear; however, several theories have been postulated (1, 2). Herein we present a histologically proven case of CAD of the popliteal artery in a 53-year-old man. We describe the imaging findings on gray-scale, Doppler and triplex ultrasonography (US), computed tomography (CT) with 3D reconstruction, and digital subtraction angiography (DSA). Case reportA 53-year-old man with a medical history remarkable only for a 30 pack/ year smoking was referred to our department because of a 2-year history of intermittent claudication of the right calf that worsened during the last 4 months. Other than cigarette-smoking, the patient had no risk factors for vascular disease. Clinical examination revealed diminished popliteal and pedal pulses on the affected side. Other clinical and laboratory findings were normal, and the patient was in excellent condition.Gray-scale and Doppler US demonstrated an ovoid cystic structure of about 20 x 15 mm, compressing the right popliteal artery and causing severe narrowing of the lumen. Spectral analysis of the popliteal artery demonstrated an abnormal arterial spectrum proximal to, within, and distal to the stenosis (Fig. 1). Subtle atheromatous changes with no significant arterial stenosis were also found in the arteries of both legs. Diagnosis of CAD was suspected, and the patient was referred for further imaging evaluation.CT angiography of the popliteal artery confirmed the cystic nature of the lesion (23 HU) that was in contact with the popliteal artery, causing almost complete occlusion of the vessel lumen. Small arterial collaterals were also demonstrated. Further evaluation with 3D-CT reconstructions using the volume rendering technique was performed for better preoperative planning (Fig. 2).DSA was then performed in order to demonstrate more clearly the degree of the stenosis, the collaterals, and other potential stenoses from the arteries of the lower limbs not demonstrated in previous studies. DSA demonstrated almost compete occlusion of the right popliteal artery for a length of 15 mm, while there were no other stenoses in the arteries of the lower limbs (Fig. 3).It was finally decided that surgery should be performed because of the patient's persistent symptoms. At surgery, a cystic lesion was found, filled with a viscous, mucous fluid in the wall of the popliteal artery. The wall of the cyst was carefully dissected, and the popliteal artery was decompressed (Fig. 4a). Histopathology of the surgical specimen revealed a section of the wall of a large artery, with findings consistent with CAD (Fig. 4b). CARDIOVASCULAR IMAGING CASE REPORT Cystic adventitial disease of the popliteal arteryMichael Michaelides, Stavroula Pervana, Charis Sotiridadis, Ioannis Tsitouridis ABSTRACT Cystic adventitial disease is a rare condition that usually affect...

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

“…Pathogenesis of this entity is unclear, but four theories have been proposed (3,6). The trauma theory suggests chronic degeneration by repetitive trauma.…”

mentioning

confidence: 99%

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Cystic adventitial disease of the popliteal artery

Michaelides

Pervana²,

Sotiridadis³

et al. 2009

Diagn Interv Radiol

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Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint‐connected

et al. 2012

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Cystic adventitial disease (CAD) is a rare condition in which cyst is found within a vessel, typically producing symptoms of vascular compromise. Most commonly located in the popliteal artery near the knee, it has been reported in arteries and veins throughout the body. Its pathogenesis has been poorly understood and various surgical approaches have been recommended. We extrapolated some recent information about a similar condition, intraneural ganglion cyst affecting the deep fibular (peroneal) nerve, to the prototype, CAD of the popliteal artery. In intraneural ganglion cysts affecting the deep fibular nerve we have shown that an articular (neural) branch is the conduit between the superior tibiofibular joint and the main parent nerve for which epineurial dissection of joint fluid can occur. We hypothesized that the same principles would apply to CAD and that an articular (vascular) branch would be the conduit from the knee joint leading to dissection to the main parent vessel. We reviewed five patients with CAD of the popliteal artery in whom MRIs were available: two treated by the primary author well familiar with the proposed articular theory, and three treated by others at our institution, less familiar with it. We then reviewed the literature critically to assess for additional evidence to support our articular (synovial) theory and an anatomic explanation. In the two cases treated by the primary author a joint connection was identified on high resolution MRI prospectively and intraoperatively through the middle genicular artery (MGA); postoperatively in these cases there was no recurrence. In the other three cases, a joint connection was not identified on imaging or at operation. Reinterpretation of these cases revealed a joint connection through the MGA in the one patient who had preoperative imaging and subclinical persistence/recurrence in the two patients who underwent postoperative MRIs done for other reasons. Our review of the literature and imaging studies revealed unrecognized joint connections in CAD to the knee and other joints as well as evidence that the MGA is the conduit in cases of CAD of the popliteal artery. We believe that adventitial cysts originate in neighboring joints and dissect within articular (vascular) branches. In our opinion, the unifying articular theory and the principles introduced for intraneural ganglion cysts apply equally to common and rare sites of adventitial cysts.

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Extremity Arteries

Schäberle¹

2018

Ultrasonography in Vascular Diagnosis

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Bilateral Adventitial Cystic Disease of the Popliteal Artery: A Case Report

Cited by 39 publications

References 19 publications

Cystic adventitial disease of the popliteal artery

Cystic adventitial disease of the popliteal artery

Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint‐connected

Extremity Arteries

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