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

Tsilimparis, Nikolaos; Hanack, U.; Yousefi, Sharom; Alevizakos, P.; Rückert, Ralph I.

doi:10.1016/j.jvs.2007.01.051

Cited by 78 publications

(71 citation statements)

References 21 publications

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“…the developmental theory; mucin secreting cells placed in the adventitia from nearby joint. 6,7) The patient showed no relationship between CFA and joint and there were no urate crystals in the surgical specimen, therefore obvious causes have not yet been identified. …”

Section: Discussionmentioning

confidence: 98%

Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature

Maeda

Umeda

Kawachi

et al. 2016

ATCS

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Purpose: Cystic adventitial artery disease is an uncommon non-atherosclerotic peripheral vessel disease. Furthermore cystic adventitial disease of the common femoral artery is an extremely rare entity. We report the case of a 54 year-old man complaining of intermittent claudication who was referred to our vascular service. Methods and Results: Doppler ultrasound and multidetector-row computed tomography (CT) with 3-dimensional volume rendering revealed severe stenosis with cystic an adventitial cyst in the common femoral artery. Intra-operative Doppler ultrasound showed the cyst to be multilocular type. Reversed great saphenous vein interposition was successfully placed. Conclusion: Removal of cyst together with artery and interposition using reversed great saphenous vein is the optimal treatment procedure to prevent recurrence.

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Section: Discussionmentioning

confidence: 98%

Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature

Maeda

Umeda

Kawachi

et al. 2016

ATCS

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“…When the vessel is not totally occluded, as in our case, incision of the cyst with resection of the adventitia and evacuation of the contents is the method of choice, preventing recurrence. When the artery is totally occluded and thrombosed, reconstruction with an autologous vein graft is recommended (2).…”

Section: Discussionmentioning

confidence: 99%

“…Fewer than 400 cases have been reported in the literature (1,2). 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).…”

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confidence: 99%

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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“…Theoretically, the popliteal artery is subjected to repetitive stretching and distortion, causing destruction as well as cystic degeneration of the vessel adventitia. The repeated shearing force cause small detachments of the adventitia from the media with intramural hemorrhage which then subsequently develop into the cysts within the adventitial (5,6). Although the trauma theory enjoys the most support, there are also flaws.…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

Cystic adventitial disease—case series and review of literature

Li¹,

King²,

Velasco³

et al. 2017

Ann. Transl. Med.

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Cystic adventitial disease (CAD) is a rare vascular disorder that involves the arteries and rarely the veins, most commonly found in the popliteal artery of male patients. Etiology of CAD is uncertain and currently without a consensus agreement. Clinically, the most common presenting symptom is claudication.Diagnosis requires a strong clinical suspicion in patients with intermittent claudication, but without other risk factors for atherosclerotic disease. Angiography, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used for diagnosis. Treatment of CAD can be done via surgical resection or percutaneous intervention such as aspiration. CAD can rarely recur after treatment. Case presentation Case 1A 54-year-old male who presented after an abnormal ultrasound (US) with Doppler exam at an outside institution with a 2 months history of new, progressive right leg claudication. His medical history is significant for hypertension and a maternal history of fatal abdominal aortic aneurysm rupture. The patient states a history of trauma to the right knee of uncertain nature. He denies illicit drug use but confirms a long history of cigarette smoking. Review of systems is otherwise negative. On physical examination, no swelling, varicose veins or stiffness in the right leg were identified. The right pedal pulses were palpable but greatly reduced. The left leg is unremarkable. The initial abnormal Doppler US performed at an outside institution (image not available) reported a 1.5 cm right popliteal artery aneurysm with a possible dissection within this aneurysm and luminal narrowing. An urgent computed tomography angiography (CTA) abdomen and pelvis with runoff was performed which demonstrated a cystic structure intimately associated with the right above-theknee popliteal artery, causing near complete occlusion (Figures 1,2) without evidence of dissection. A presumptive diagnosis of cystic adventitial disease (CAD) is made at this time, and the patient was taken to the operating room for definitive diagnosis and management. A posterior surgical approach was taken and a cyst in the wall of the right popliteal artery was identified. The cyst was entered with the evacuation of viscous, jelly-like amber material. The entire cyst wall was resected. There was strong distal popliteal artery pulse status post cystectomy. The patient had an unremarkable recovery. Follow up with Doppler US performed at 2 and 4 months post-cystectomy showed a normal right popliteal artery, without evidence of cyst recurrence. Case 2A 58-year-old male developed an acute onset of left lower extremity claudication and numbness. There were no resting pain, skin ulcerations or prior history of claudication symptoms. On physical examination, the patient's right lower extremity pulses were within normal limits. The left lower extremity pedal pulses were palpable but reduced, and became nonpalpable with left knee flexion (positive Ishikawa sign). A Doppler US demonstrated an anechoic lesion intimately associat...

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

Cited by 78 publications

References 21 publications

Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature

Cystic Adventitial Disease of the Common Femoral Artery. Case Report and Review of the Literature

Cystic adventitial disease of the popliteal artery

Cystic adventitial disease—case series and review of literature

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