Cystic Adventitial Disease of the Popliteal Artery Causing Intermittent Exertional Claudication in a Young Male Athlete

Abstract

Cystic adventitial disease (CAD) is a rare disease entity of unknown origin most commonly affecting the popliteal artery. It typically occurs in otherwise healthy, middleaged male patients, causing symptoms of sudden-onset progressive intermittent claudication. Cystic adventitial disease has been well studied in the vascular literature since the disease was first defined in 1947. 1,3,7 However, the vast majority of these cases have been older patients who do not participate in significant athletic activity. 4,5,8,10 Cystic adventitial disease in the younger athlete can be extremely difficult to diagnose and must be considered within the broader spectrum of musculoskeletal, vascular, and neurological conditions that can cause exertional leg pain in the active patient. 16 The purpose of this case report is to present the symptoms, physical examination findings, diagnostic imaging results, and surgical treatment of a young male athlete with symptomatic CAD of the popliteal artery. We discuss the necessity of distinguishing CAD from a number of orthopaedic conditions with similar initial presentations and stress the importance of prompt vascular imaging for diagnosis.

Cystic adventitial disease masquerading as ganglion disease: a rare cause of intermittent claudication

“…CAD is a rare cause of intermittent claudication, accounting for 1 in 1200 presentations 1–4. Mucoid cyst formation within the adventitia of an artery leads to luminal narrowing.…”

Incidental Finding of Adventitial Cystic Disease of the Common Femoral Vein: Case Report and Review of the Literature

“…This approach requires venous reconstruction and its inherent complications and risks, but affords the lowest recurrence (0% to date). 1–3,5,9…”

“…ACD of the venous system frequently presents with unilateral lower extremity swelling, groin mass and pain, and occasionally DVT is present. [1][2][3][4]9 Imaging is often obtained in diagnostic evaluation and includes ultrasound, CT, and magnetic resonance imagining (MRI). Appropriately, ultrasound is commonly the initial study and may demonstrate a single or multiple thin-walled fl uid-fi lled cysts of the vessel wall.…”

“…This approach requires venous reconstruction and its inherent complications and risks, but affords the lowest recurrence (0% to date). [1][2][3]5,9 No compelling evidence exists to continue anticoagulation during the perioperative period. Some authors have elected to continue anticoagulation with no recurrence of DVT or complications while others have elected against anticoagulation with similar results.…”

Knee MRI: Vascular Pathology

“…Patients are usually young or middleage men who present with intermittent knee claudication [37]. The estimated incidence is 1 in 1200 per year who present with lower extremity claudication [38].…”