Surgical Management of Cystic Adventitial Disease of the Popliteal Artery

Abstract

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format.

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

“…Less than 400 cases of CAD have been reported in the literature, and of those 85% of cases have been reported in the popliteal artery 1 3 6–8. CAD is four to five times more likely to occur in men than women, commonly presenting in people in their fifth and sixth decades of life without significant risk factors for atherosclerotic disease 1–4 9 10. It is usually unilateral 1 3 6–8 11…”

“…Though the aetiology of CAD is unknown, four theories have been proposed to clarify the pathophysiology of CAD: repeated trauma prompting adventitial degeneration; a systemic process; the incorporation of mucin-producing mesenchymal cells into vessel adventitia during embryological development; and migration of synovial cysts that implant into adventitia through communicating branches 1 2 4 9–14. The synovial cyst hypothesis is becoming more widely accepted, and it has been demonstrated that the middle genicular artery is a communicating branch between the joint and the popliteal artery 11.…”

“…Symptoms often worsen with exertion or knee flexion. Clinically, patients may demonstrate the Ishikawa sign, whereby popliteal and pedal pulses diminish with knee flexion 3 10…”

“…CAD can be diagnosed on conventional angiography by identifying a smooth contour of contrast above and below the lesion (scimitar sign), or an hourglass appearance seen with concentric compression 1–3 13 15. When seen during duplex ultrasonography, a hypoechoic or anechoic cystic structure can be seen with or without septations, and the lumen of the artery may appear stenosed with either turbulent or absent flow on Doppler 1 2 10. Although duplex ultrasound is a sensible first-line investigation in the setting of new claudication, the lack of cross-sectional imaging limits surgical planning compared with CTA and MRA,4 7 it can be difficult to distinguish CAD from a thrombosed aneurysm1 and appearances may be normal resulting in misdiagnosis 7.…”

Cystic Adventitial Disease of the Common Femoral Vein

“…An English literature review revealed that the popliteal artery is the most common vessel to be affected by CAVD, with at least 85 reported cases, [1][2][3][4][5][6][7] followed by the femoral artery, 8,9 the radial artery, the saphenous vein, 10 and the CFV. [11][12][13][14][15] Axillary and radial artery involvement has also been reported.…”