Percutaneous Image-Guided Aspiration and Sclerosis of Adventitial Cystic Disease of the Femoral Vein

Abstract

Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease mainly seen in arteries. Seventeen cases have been reported in the world literature. We report the first known case of ACD successfully treated with percutaneous image-guided ethanol sclerosis. Computed tomography showed a cystic mass adherent to the wall of the common femoral vein. An ultrasound examination revealed a deep venous thrombosis of the leg, secondary to extrinsic compression of the common femoral vein. Three years prior to our procedure, the cyst was aspirated, which partially relieved the patient's symptoms. Over the following 3 years the patient's symptoms worsened and a 10-cm discrepancy in thigh size developed, in addition to the deep venous thrombosis associated with lower-extremity edema. Using ultrasound guidance and fluoroscopic control, the cyst was drained and then sclerosed with absolute ethanol. The patient's symptoms and leg swelling resolved completely within several weeks. Follow-up physical examination and duplex ultrasound 6 months following sclerosis demonstrated resolution of the symptoms and elimination of the extrinsic compression effect of the ACD on the common femoral vein.

Venous Adventitial Cystic Disease: A Review of 45 Cases Treated Since 1963

“…Minimally invasive management has been reported with image-guided needle aspiration of adventitial cysts, but incomplete evacuation of cysts secondary to high viscosity and the mucin-secreting mesenchymal cells that are left in situ had resulted in high recurrence rates [6, 11]. Endovascular treatment is also ineffective because it fails to deal with the underlying cause of compression and may become problematic with stent's crossing joint lines and with thrombosis in low flow veins [19]. Therefore, it is essential for physicians to utilize surgical intervention as the treatment of choice.…”

Adventitial cystic disease of the femoral vein in a 5-year-old boy mimicking deep venous thrombosis

“…There are only 32 reported cases of ACD of the vein in the world literature, including this case. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] In contrast, adventitial cystic disease of the artery is a well-described, if rare, cause of intermittent lower extremity arteriogenic claudication occurring in 1:1200 cases of claudication. 19,20 ACD of the artery involves the popliteal artery in 85% of cases.…”

“…16 In addition to differences in distribution of affected vessels, distribution of disease between genders also differs when arterial ACD is compared to venous ACD. ACD of the artery affects men much more commonly than women, with a male:female ratio of 15:1.…”

Percutaneous Ethanol Sclerotherapy for Recurrent Adventitial Cystic Disease of External Iliac Vein after Surgical Treatment: A Case Report

“…We also used absolute ethanol for sclerotic agent for the prevention of recurrence, as it damages endothelium of vessel wall and promote sclerosis (4). Also, we chose the absolute ethanol as sclerotic agent, as it is most widely used sclerotic material in out institution.…”