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Louis H, Philip L. Cystic adventitial disease of the common femoral artery: a case report and overview of the literature. Acta Chir Belg 2024; 124:316-324. [PMID: 38563142 DOI: 10.1080/00015458.2024.2313263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/28/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Cystic adventitial disease (CAD) is an uncommon condition that affects arteries and veins. It can cause a rare type of non-atherosclerotic peripheral vessel disease. The most common vessel affected is the popliteal artery. The number of case reports on CAD of the femoral artery is growing. We present a case of a 62-year-old female presented with claudication of the left leg diagnosed with CAD of the left common femoral artery. The patient was treated surgically with cyst excision and vessel reconstruction with saphenous vein autograft patch plasty. After 8-months the cyste relapsed and she had new claudication complains. We decided to perform new surgery. Surgical treatment consisted of cyst resection by excision of the femoral bifurcation and saphenous vein autograft interposition reconstruction of the bifurcation. We also provide an update on the latest literature of surgical treatment of CAD of the ilio-femoral artery region. METHODS Medline and EMBASE were used to collect articles on CAD of ilio-femoral artery. We included English written or translated case reports or series between 1987 and 2023. RESULTS Twenty-nine patients out of 28 case reports were included. Most patients were male (59%). Claudication is the most common symptom (76%). Treatment consisted of cyst resection, cyst decompression, Endarterectomy, patch angioplasty and interposition graft using PTFE, Dacron, Great saphenous vein (GSV) or femoral vein autograft. Recurrence appeared in 4 cases (14%). CONCLUSION In accordance to the literature and our experience we recommend complete vessel excision and saphenous vein (or PTFE) interposition bypass as treatment.
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Affiliation(s)
- Haentjens Louis
- Department of Thoracic and vascular Surgery, AZ Groeninge, Kortrijk, Belgium
| | - Lerut Philip
- Department of Thoracic and vascular Surgery, AZ Groeninge, Kortrijk, Belgium
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2
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Sassi F, Azouz H, Hermes S, Zehani A, Haouet S. Cystic adventitial disease of the popliteal artery: A case report with review of literature. Int J Surg Case Rep 2024; 117:109541. [PMID: 38522307 PMCID: PMC10973812 DOI: 10.1016/j.ijscr.2024.109541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cystic adventitial disease (CAD) is a rare vascular disorder marked by occlusion stemming from the development of a cystic mass within the outer (subadventitial) layer, with a predominant impact on the popliteal artery. The significance of the case presented herein lies in shedding light on a distinct clinical manifestation involving a 40-year-old man who exhibited sporadic calf claudication during ambulation. This instance contributes to the broader understanding of CAD and its diverse clinical presentations, emphasizing the need for further exploration and awareness within the medical community. CASE PRESENTATION A 40-year-old man, with no significant past medical history, was referred to the cardiovascular department for the evaluation of a new onset of left calf pain persisting over the past three months. An arterial lower limb Doppler ultrasound was performed, revealing a focal hypoechoic image around the popliteal artery with a regular arterial wall, indicative of extrinsic compression. This resulted in significant stenosis of the popliteal artery during plantar flexion of the foot. The diagnosis of CAD of the left popliteal artery was established after limb computed tomography angiography, and a complete resection of the cyst was scheduled. The postoperative course was uneventful, with the patient experiencing relief from left calf claudication. CLINICAL DISCUSSION CAD is an uncommon vascular anomaly, representing merely 0.1 % of all vascular conditions. This condition predominantly afflicts men aged between 40 and 50 years old. The etiology of CAD remains a subject of debate, with pathological findings typically involving intramural cysts containing gelatinous material between the media and the adventitia. Surgical intervention becomes necessary when symptoms arise. CONCLUSION CAD of the popliteal artery, though rare, is a significant contributor to peripheral vascular insufficiency in young patients without typical atherosclerotic risk factors.
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Affiliation(s)
- Farah Sassi
- Pathology Department, Rabta hospital, Tunis, Tunisia.
| | - Heifa Azouz
- Pathology Department, Rabta hospital, Tunis, Tunisia
| | | | - Alia Zehani
- Pathology Department, Rabta hospital, Tunis, Tunisia
| | - Slim Haouet
- Pathology Department, Rabta hospital, Tunis, Tunisia
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3
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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4
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Lenartowicz K, Howe BM, Amrami KK, Desy NM, Houdek MT, Spinner RJ. Tibial intraneural ganglion cysts at the superior tibiofibular joint treated with joint resection alone: a proof of concept. Acta Neurochir (Wien) 2023; 165:2581-2588. [PMID: 37273006 DOI: 10.1007/s00701-023-05639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intraneural ganglion cysts involving the tibial nerve are rare. Recent evidence has supported an articular (synovial) theory to explain the joint-related origin of these cysts; however, optimal operative treatment for cysts originating from the STFJ remains poorly understood. Therefore, we present a novel strategy: addressing the joint itself without addressing the articular branch and/or the cyst. METHODS Records of patients with tibial intraneural ganglion cysts with a connection to the STFJ who were treated with a joint resection alone at a single academic institution were reviewed. The clinicoradiographic features, operative intervention, and postoperative course were recorded. RESULTS We identified a consecutive series of 7 patients. These patients (4/7 male, 57%) were 43 (range 34-61) years of age and all presented with symptoms of neuropathy. The patients underwent resection of the synovial surfaces of the STFJ without disconnection of the articular branch or decompression of the cyst. Postoperatively, three patients regained partial motor function (43%, n=7), although four patients noted continued sensory abnormality (57%, 4/7). All six patients with postoperative MRIs had some evidence of regression of the cyst. CONCLUSIONS This novel surgical technique serves as a proof of concept-highlighting the fact that treating the primary source (the joint origin) can be effective in eliminating the secondary problem (the cyst itself). While this study shows that this simplified approach can be employed in select cases, we believe that superior results (faster, fuller recovery) can be achieved with combinations of disconnecting the articular branch, decompressing the cyst, and/or resecting the joint.
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Affiliation(s)
- Karina Lenartowicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - B Matthew Howe
- Departments of Radiology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Kimberly K Amrami
- Departments of Radiology, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Nicholas M Desy
- Department of Orthopedics, University of Calgary, Calgary, AB, T2N 1N4, Canada
| | - Matthew T Houdek
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, 55905, USA
| | - Robert J Spinner
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, 55905, USA.
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, 55905, USA.
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5
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Lenartowicz KA, Wolf AS, Desy NM, Strakowski JA, Amrami KK, Spinner RJ. Preoperative Imaging of Intraneural Ganglion Cysts: A Critical Systematic Analysis of the World Literature. World Neurosurg 2022; 166:e968-e979. [PMID: 35953037 DOI: 10.1016/j.wneu.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Advancements in imaging and an understanding of the pathomechanism for intraneural ganglion cyst formation have led to increased awareness and recognition of this lesion. However, the precise role of imaging has been advocated for but not formally evaluated. METHODS We performed a systematic review of the world literature to study the frequency of imaging used to diagnose intraneural ganglion cysts at different sites and compared trends in identifying joint connections. RESULTS We identified 941 cases of intraneural ganglion cysts, of which 673 had published imaging. Magnetic resonance imaging (MRI, n = 527) and ultrasonography (US, n = 123) were the most commonly reported. They occurred most frequently in the common peroneal nerve (n = 570), followed by the ulnar nerve at the elbow (n = 88), and the tibial nerve at the ankle (n = 58). A joint connection was identified in 375 cases (48%), with 62% of MRIs showing a joint connection, followed by 16% on US, and 6% on computed tomography (CT). MRI was statistically more likely to identify a joint connection than was US (P < 0.01). In the last decade, joint connections have been identified with increasing frequency using preoperative imaging, with up to 75% of cases reporting joint connections. CONCLUSIONS Preoperative imaging plays an important role in establishing the diagnosis of intraneural ganglion cyst as well as treatment planning. Imaging has proved superior to the sole reliance of operative exposure to identify a joint connection, which is necessary to treat the underlying disease. Failure to identify cyst connections on imaging can result in an inability to truly address the underlying pathoanatomy at the time of definitive surgery, leading to a risk for clinical recurrence. Therefore, management should be guided by an intersection between new knowledge presented in the literature, clinical expertise, and surgeon experience.
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Affiliation(s)
| | - Alexandre S Wolf
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas M Desy
- Department of Orthopedics, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey A Strakowski
- Department of Physical Medicine and Rehabilitation, Ohio Health, Columbus, Ohio, USA
| | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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6
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Woo HY, Hur S, Jae HJ, Min SK. Inadvertent Stenting and Percutaneous Aspiration for Treatment of Adventitial Cystic Disease in the Popliteal Artery: A Case Report. Vasc Specialist Int 2022; 38:21. [PMID: 35770655 PMCID: PMC9244723 DOI: 10.5758/vsi.220020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/20/2022] Open
Abstract
Adventitial cystic disease (ACD) is a rare, non-atherosclerotic disease that mainly affects the popliteal artery. Treatment is primarily surgical as endovascular approaches are affected by high recurrence rates. However, some studies have reported successful endovascular treatments of popliteal ACD cases. A 55-year-old female presented with right calf claudication. Computed tomography angiography revealed segmental occlusion of the right distal superficial femoral artery. Subsequently, a drug-eluting stent was successfully deployed. However, an unusual adventitial cystic lesion occluding the lumen that was characteristic of ACD was detected during a postoperative imaging review. It was aspirated using an ultrasound-guided percutaneous needle and drained using a pigtail catheter for 24 hours. Follow-up images after 39 months showed a patent artery with no recurrence of any cystic lesions, highlighting successful ACD treatment via stenting, ultrasound-guided aspiration, and cyst drainage. Stenting and cyst aspiration can be an alternative option for selected patients with ACD.
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Affiliation(s)
- Hye Young Woo
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Saebeom Hur
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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7
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Affes M, Chaabouni M, Attia M, Jaber C, Baccouche I, Kchaou S, Nèji H, Hantous‐Zannad S. Cystic adventitial disease of the popliteal artery with unusual spontaneous regression: A case report with literature review. Clin Case Rep 2022; 10:e05757. [PMID: 35441026 PMCID: PMC9010954 DOI: 10.1002/ccr3.5757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
This report highlights the case of cystic adventitial disease of the left popliteal artery in a 45‐year‐old male patient. Imaging modalities confirmed the diagnosis and high resolution MRI found a cystic connection to the adjacent knee joint. The evolution was unusual with spontaneous regression of the symptoms.
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Affiliation(s)
- Meriem Affes
- Department of Radiology Abderrahmen Mami Hospital Ariana Tunisia
- Faculty of medicine of Tunis Tunis El Manar University Ariana Tunisia
| | | | - Monia Attia
- Department of Radiology Abderrahmen Mami Hospital Ariana Tunisia
- Faculty of medicine of Tunis Tunis El Manar University Ariana Tunisia
| | - Chaker Jaber
- Faculty of medicine of Tunis Tunis El Manar University Ariana Tunisia
- Department of thoracic and Cardiovascular Surgery Abderrahmen Mami Hospital Ariana Tunisia
| | - Ines Baccouche
- Department of Radiology Abderrahmen Mami Hospital Ariana Tunisia
| | - Salma Kchaou
- Department of Radiology Abderrahmen Mami Hospital Ariana Tunisia
| | - Henda Nèji
- Department of Radiology Abderrahmen Mami Hospital Ariana Tunisia
- Faculty of medicine of Tunis Tunis El Manar University Ariana Tunisia
| | - Saoussen Hantous‐Zannad
- Department of Radiology Abderrahmen Mami Hospital Ariana Tunisia
- Faculty of medicine of Tunis Tunis El Manar University Ariana Tunisia
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Flynn D, Tesar J, Peden S, Quinn S, Kruger A, Jenkins J. Venous cystic adventitial disease: to cure or manage? A case series. BMJ Case Rep 2022; 15:e247813. [PMID: 35027391 PMCID: PMC8762143 DOI: 10.1136/bcr-2021-247813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/04/2022] Open
Abstract
Venous cystic adventitial disease is a rare vascular condition that can have significant effects on a patient's quality of life. The clinical presentation of venous cystic adventitial disease is variable, and there are no established guidelines on investigation or treatment of the disease. We present a series of three patients with venous cystic adventitial disease of the common femoral vein, treated within a single vascular surgery unit. Each of the three patients presented within 18 months of each other, despite the rarity of the disease. These are the only known cases treated within this vascular surgery unit. The investigation, management and treatment of each patient are individualised, with a management focus on quality of life.
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Affiliation(s)
- David Flynn
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Joshua Tesar
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Samantha Peden
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Simon Quinn
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Allan Kruger
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jason Jenkins
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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9
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Wang Q, Cheng Z, Tang L, Wang Q, Zhang P, Zhang H. Cystic Adventitial Disease of the Common Femoral Artery: A Rare-Case Report. Front Surg 2022; 8:814036. [PMID: 35087863 PMCID: PMC8786711 DOI: 10.3389/fsurg.2021.814036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Herein, we report the case of a 59-year-old man with intermittent claudication of ~100 m, who complained of resting pain in his lower right extremity. A pelvic, contrast-enhanced, computed tomography scan showed the presence of cystic density in the lower segment of the right common femoral artery. Faced with the risk of acute limb ischemia, we navigated a challenging diagnostic procedure to choose an appropriate treatment for him. Additionally, we performed a pathological investigation of the excised common femoral artery following the excision bypass. On postoperative day 5, the patient was discharged from the hospital. During the 2-year follow-up, no new cysts were discovered, and the patient had favorable prognosis.
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Affiliation(s)
- Qilong Wang
- Department of Vascular Surgery, The First Bethune Hospital of Jilin University, Changchun, China
| | - Zhihua Cheng
- Department of Vascular Surgery, The First Bethune Hospital of Jilin University, Changchun, China
| | - Liang Tang
- Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China
| | - Qi Wang
- Department of Vascular Surgery, The First Bethune Hospital of Jilin University, Changchun, China
| | - Ping Zhang
- Department of Hepatopancreatobiliary Surgery, The First Bethune Hospital of Jilin University, Changchun, China
- *Correspondence: Ping Zhang
| | - Hua Zhang
- Department of Vascular Surgery, The First Bethune Hospital of Jilin University, Changchun, China
- Hua Zhang
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10
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Biggs JH, Kalra M, Skinner JA, DeMartino RR. Adventitial cystic disease of the common femoral vein: an unusual cause of lower extremity swelling and review of the literature. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:610-616. [PMID: 34746527 PMCID: PMC8551497 DOI: 10.1016/j.jvscit.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/25/2021] [Indexed: 11/24/2022]
Abstract
We report the case of a 61-year-old man who had presented with acute unilateral limb swelling. Computed tomography venography and duplex ultrasound demonstrated compression of the right common femoral vein by a common femoral vein adventitial cyst. Before intervention, the patient had developed an acute deep vein thrombosis of the right common femoral vein and great saphenous vein. Preoperative magnetic resonance imaging demonstrated concern for synovial connection. After 6 months of anticoagulation therapy, the patient underwent adventitial cyst excision with ligation of the hip joint articular connection. At 4 months postoperatively, the patient was symptom free without cyst recurrence. The findings from the present case support the synovial theory for adventitial cystic disease.
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Affiliation(s)
- Joedd H Biggs
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
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12
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Spinner RJ. A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways. Clin Anat 2021; 34:1165-1172. [PMID: 34309059 DOI: 10.1002/ca.23768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 12/25/2022]
Abstract
By recognizing anatomic and radiologic patterns of rare and often misdiagnosed peripheral nerve tumors/lesions, we have defined mechanisms for the propagation of neural diseases. The novel concept of the nervous system serving as a complex system of "highways" driving the neural and perineural spread of these lesions is described in three examples: Intraneural dissection of joint fluid in intraneural ganglion cysts, perineural spread of cancer cells, and dissemination of unknown concentrations of neurotrophic/inhibitory factors for growth in hamartomas/choristomas of nerve. Further mapping of these pathways to identify the natural history of diseases, the spectrum of disease evolution, the role of genetic mutations, and how these neural pathways interface with the lymphatic, vascular, and cerebrospinal systems may lead to advances in targeted treatments.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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13
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Smith BW, Jack MM, Powell GM, Frick MA, Amrami KK, Spinner RJ. High-resolution MRI of a peroneal intraneural ganglion cyst arising from the knee joint: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE21130. [PMID: 35854869 PMCID: PMC9245746 DOI: 10.3171/case21130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The advancement of high-resolution imaging and increased clinical experience have led to an increased understanding of the formation and treatment of intraneural ganglion cysts. Nearly all intraneural ganglion cysts in the common peroneal nerve have been reported to arise from a joint connection to the superior tibiofibular joint. The authors have identified four cases of intraneural ganglion cysts arising from the knee joint itself; however, none of these reported cases were well described, documented, or illustrated with high-resolution imaging. OBSERVATIONS Here the authors present the case of an intraneural ganglion cyst arising from the knee joint and causing intermittent weakness and pain. The articular branch to the knee joint was clearly demonstrated on high-resolution magnetic resonance imaging and confirmed at surgical exploration. The patient was treated with articular branch ligation and has had complete resolution of his symptoms without recurrence of the cyst on follow-up imaging. LESSONS This case adds to the mounting evidence that intraneural cyst pathology is dependent on a connection to a synovial joint as stated in the unifying theory of intraneural cyst development.
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14
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Ching-Yee Chan M, Cornwall J, Ilonzo N, McKinsey J. Cystic adventitial disease of the popliteal vein and artery in siblings. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:545-548. [PMID: 34401622 PMCID: PMC8358288 DOI: 10.1016/j.jvscit.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
Cystic adventitial disease (CAD) is an uncommon condition in which mucoid cysts form within the adventitial layer of the arterial or venous wall. We have presented two cases in which two first-degree relatives (brother and sister) had acquired CAD ∼6 years apart, one involving the popliteal artery and the other involving the popliteal vein. We have reported a rare case of a possible familial association of CAD. We have discussed the etiology, diagnostic criteria, and imaging modalities between arterial and venous CAD to aid in the management and selection of optimal treatment strategies.
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Affiliation(s)
- Mabel Ching-Yee Chan
- Department of Surgery, Icahn School of Medicine, Mount Sinai Morningside and West Hospitals, New York, NY
| | - James Cornwall
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Nicole Ilonzo
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - James McKinsey
- Department of Surgery, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
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15
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Mikhaylov IP, Lavrenov VN, Titova GP, Lepekhina IS. [Adventitial cyst of the popliteal artery]. Khirurgiia (Mosk) 2021:83-89. [PMID: 33395517 DOI: 10.17116/hirurgia202101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vascular cystic adventitious degeneration (CAD) is a rare disease of unclear etiology that affects mainly the popliteal artery (up to 85-90% of cases). Clinical manifestations are similar to aneurysm of the popliteal artery. CAD occurs mainly in males of the 4th and 5th decades of life (range 10-77 years). These patients usually have no risk factors of cardiovascular diseases. Unilateral symptoms prevail. We report a review and a 46-year-old patient with CAD of the popliteal artery.
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Affiliation(s)
- I P Mikhaylov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - V N Lavrenov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - G P Titova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I S Lepekhina
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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16
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Esposito D, Masciello F, Dorigo W, Alessi Innocenti A, Santi R, Nesi G, Pratesi C. An unexpected intraoperative finding of cystic adventitial degeneration of the common femoral artery. J Surg Case Rep 2020; 2020:rjaa200. [PMID: 32821365 PMCID: PMC7427030 DOI: 10.1093/jscr/rjaa200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Herein we present a rare case of cystic adventitial degeneration involving the common femoral artery (CFA) of a 71-year-old patient, an unusual site of presentation of the disease. The most commonly affected district is the popliteal artery, and only a few cases of CFA involvement are described in literature. The history and comorbidities of the patient oriented us initially towards the diagnosis of an atherosclerotic obstructive disease. It was only intraoperatively indeed that a diagnosis of cystic adventitial arterial degeneration was made, subsequently confirmed by microscopic examination. Our case shows how both clinical and instrumental diagnosis of cystic adventitial disease can be challenging, given its non-specific presentation and low incidence. Suspicion of cystic adventitial degeneration is recommended in patients with sudden appearance of symptoms and with an isolated lesion of the affected artery without other involvement of the vascular tree.
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Affiliation(s)
- Davide Esposito
- Vascular Surgery Department, Careggi University Hospital, 50134, Florence, Italy
| | - Fabrizio Masciello
- Vascular Surgery Department, Careggi University Hospital, 50134, Florence, Italy
| | - Walter Dorigo
- Vascular Surgery Department, Careggi University Hospital, 50134, Florence, Italy
| | | | - Raffaella Santi
- Pathological Anatomy Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Gabriella Nesi
- Pathological Anatomy Unit, Careggi University Hospital, 50134, Florence, Italy
| | - Carlo Pratesi
- Vascular Surgery Department, Careggi University Hospital, 50134, Florence, Italy
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17
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Min SK, Han A, Min S, Park YJ. Inconsistent Use of Terminology and Different Treatment Outcomes of Venous Adventitial Cystic Disease: A Proposal for Reporting Standards. Vasc Specialist Int 2020; 36:57-65. [PMID: 32611837 PMCID: PMC7333088 DOI: 10.5758/vsi.200029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 01/21/2023] Open
Abstract
Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.
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Affiliation(s)
- Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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18
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Cystic Adventitial Disease of the Popliteal Artery: Radical Surgical Treatment After Several Failed Approaches. A Case Report and Review of the Literature. Ann Vasc Surg 2020; 64:411.e5-411.e11. [DOI: 10.1016/j.avsg.2019.10.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/20/2022]
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19
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Tanaka M, Shimada Y, Terada Y. A case of cystic adventitial disease of the poplitealartery: selection of incision of the cyst wall overvessel replacement. J Rural Med 2020; 15:47-49. [PMID: 32015782 PMCID: PMC6983455 DOI: 10.2185/jrm.2019-010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022] Open
Abstract
Cystic adventitial disease (CAD), a rare arterial disorder, can cause localized arterial stenosis or obstruction. A 55-year-old man presented with a 2-month history of left lower leg pain and paleness when bending the left knee. The patient was diagnosed with CAD of the left popliteal artery based on imaging examinations. Surgery was performed with the patient placed in the prone position using an S-shaped skin incision, and the left popliteal artery was exposed. A simple incision of the cyst wall was made. There was no sign of recurrence at 1 year postoperatively.
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Affiliation(s)
- Masafumi Tanaka
- Department of General Medicine, Shonai-Amarume Hospital, Japan
| | - Yasuyuki Shimada
- Department of Cardiovascular Surgery, Shonai-Amarume Hospital, Japan
| | - Yasushi Terada
- Department of Cardiovascular Surgery, Shonai-Amarume Hospital, Japan
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20
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Mertens RA, Bergoeing M, Mariné L, Vargas F, Torrealba I, Valdés F. Two Cases of Popliteal Cystic Adventitial Disease Treated with Primary Stenting: Long-Term Results. Ann Vasc Surg 2019; 63:460.e1-460.e4. [PMID: 31622749 DOI: 10.1016/j.avsg.2019.08.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/25/2019] [Accepted: 08/25/2019] [Indexed: 11/15/2022]
Abstract
The cystic adventitial disease of the popliteal artery is an uncommon cause of intermittent claudication in young patients. Several treatment options are available, oriented to either drainage of the cyst and/or arterial reconstruction. Endovascular techniques have been exceptionally used to treat this condition, with mixed results. We report 2 young claudicants treated with primary stenting with continuous 4- and 10-year symptomatic relief and arterial patency.
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Affiliation(s)
- Renato A Mertens
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Michel Bergoeing
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leopoldo Mariné
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Vargas
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Torrealba
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Valdés
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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21
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Liu P, Yan B, Zhang Y, Yan J, Ma C, Wang G, Jian T, Sun Z. Cystic adventitial disease of femoral vein presenting as enlarging lower limb swelling and pain: Two case reports and review of the literature. Exp Ther Med 2019; 18:3563-3567. [PMID: 31602233 PMCID: PMC6777217 DOI: 10.3892/etm.2019.7992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022] Open
Abstract
Cystic adventitial disease (CAD) is a condition that mainly affects the arterial system but rarely involves the venous system. The present study reported on two cases of CAD of femoral veins. The clinical manifestations in the two patients included pain and swelling of the lower limbs, but they had no risk factors for venous thrombosis. Color ultrasonography indicated cystic space-occupying lesions around the femoral veins, and enhanced computed tomography (CT) revealed vascular compression and space-occupying properties of the femoral veins. The two patients underwent open surgery, the postoperative treatment was uneventful, and swelling and tenderness were completely resolved. The pathological examination confirmed CAD of femoral vein in the two patients. The enhanced CT venography scan indicated patency of the femoral vein in the two patients following the operation. The circumferences of the two patients' lower limbs had returned to normal at the 2-month follow-up. A review of the literature was performed, and the presentation, diagnosis, treatment and pathology of this rare condition were discussed.
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Affiliation(s)
- Peng Liu
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Bin Yan
- Intensive Care Unit of Vascular Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, P.R. China
| | - Yanhui Zhang
- Department of Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Jingwei Yan
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Chong Ma
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Guodong Wang
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Tao Jian
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Ziqiang Sun
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
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22
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Lucattelli E, Menichini G, Brogi M, Roselli G, Innocenti M. Long-Term Functional Outcome After Surgical Treatment of Peroneal Intraneural Ganglion Cyst. World Neurosurg 2019; 132:e217-e222. [PMID: 31493600 DOI: 10.1016/j.wneu.2019.08.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraneural ganglia are benign mucinous cystic formations that originate within the epineurium of peripheral nerves. Different treatments have been recommended, with an overall satisfactory outcome. In this paper, we aim to evaluate the long-term outcomes of surgical treatment of peroneal intraneural ganglia by reviewing our local institutional experience. METHODS We performed a case series review of peroneal intraneural ganglia surgical treatment performed by the senior author. Demographic and surgical details were abstracted from the medical record for each patient. Electrodiagnostic studies and magnetic resonance imaging (MRI) were performed in all patients pre- and postoperatively. RESULTS Eight men were enrolled, with an average age at time of surgery of 47.5 years (range 28-68 years). Motor testing revealed a preoperative deficit of dorsiflexion, eversion, and toe extension in 7 patients, with a median preoperative Medical Research Council (MRC) score of 0/5. Sensory loss in the distribution of the common peroneal nerve was present in 7 patients. Mean clinical follow-up time was 113 months (range 32-189 months). Significant pain relief was achieved in all patients. Overall neurologic function was improved, more so for motor function. The median postoperative dorsiflexion, eversion, and toe extension at last follow-up were MRC score of 5/5. No complications occurred postoperatively. There was no clinical evidence of intraneural recurrence, as confirmed in postoperative MRI. In 2 patients, an extraneural cystic formation was visible in the anterior muscular compartment. CONCLUSIONS The data from our series support excellent long-term postoperative motor outcomes with a low recurrence rate. To avoid extraneural recurrence, resection of the superior tibiofibular joint is necessary.
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Affiliation(s)
- Elena Lucattelli
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy.
| | - Giulio Menichini
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Mattia Brogi
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
| | - Giuliana Roselli
- Radiology Department, Careggi University Hospital, Florence, Italy
| | - Marco Innocenti
- Plastic and Reconstructive Microsurgery, Careggi University Hospital, Florence, Italy
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23
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Leafblad ND, Wilson TJ, Amrami KK, Turner NS, Spinner RJ. Cystic Adventitial Disease of the Tibial Vein Arising From the Subtalar Joint: A Case Report. J Foot Ankle Surg 2019; 58:377-380. [PMID: 30612871 DOI: 10.1053/j.jfas.2018.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Indexed: 02/03/2023]
Abstract
Soft tissue ganglion cysts are a well-known cause of tibial nerve compression in the tarsal tunnel. We describe a patient who presented with tibial nerve symptoms and was found to have an adventitial cyst of the tibial vein arising from the subtalar joint, with the joint connection confirmed both on imaging and at surgery. Surgical decompression of the cyst with transection of the vascular pedicle arising from the subtalar joint improved her symptoms at 6 months, and postoperative magnetic resonance imaging showed resolution of the cyst. Cystic adventitial disease is a rare, poorly understood condition in which a cyst is identified in the adventitia of a vessel, usually an artery. Only 3 cases of adventitial cysts have been reported in the foot and ankle region, 2 in the lesser and 1 in the greater saphenous vein. None of the previous cases have been recognized to be joint connected. This case provides additional evidence for an articular origin for adventitial cysts and helps guide management strategies for these joint-connected cysts.
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Affiliation(s)
- Nels D Leafblad
- Resident, Department of Orthopedics, Mayo Clinic, Rochester, MN
| | - Thomas J Wilson
- Fellow, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | - Norman S Turner
- Assistant Professor, Department of Orthopedics, Mayo Clinic, Rochester, MN
| | - Robert J Spinner
- Professor, Department of Neurologic Surgery and Orthopedics, Mayo Clinic, Rochester, MN.
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24
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Abstract
Cystic adventitial disease (CAD) is a rare cause of unilateral intermittent claudication of unknown aetiology, which is characterized by the formation of multiple mucin-filled cysts in the adventitial layer of the arterial wall resulting in obstruction to blood flow. The disease predominantly presents in young otherwise healthy males and most commonly affects the popliteal artery (85% of cases). CAD can be diagnosed by duplex ultrasound, magnetic resonance imaging, magnetic resonance angiography, or computed tomographic angiography. Surgery is the primary mode of treatment, including exarterectomy, or replacement of the affected vascular segment by venous or synthetic interposition graft. Alternatively, the cysts can be drained by percutaneous ultrasound-guided needle aspiration. We conducted a review of the literature on the aetiology, diagnosis and treatment of this uncommon condition and present the case report.
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25
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Vaughn NH, Flemming DJ, Newell JM, Payatakes AH. Adventitial Cystic Disease of the Radial Artery. J Hand Surg Asian Pac Vol 2018; 23:581-584. [PMID: 30428811 DOI: 10.1142/s2424835518720347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Upper extremity adventitial cystic disease is rare, but the characteristic findings of this lesion should be known to the hand surgeon and used to guide treatment. We present a case of a young adult male who developed a painless mass in his distal forearm. Diagnostic imaging workup revealed a cystic mass that extended within and encased the radial artery. Both MRI and direct intraoperative visualization confirmed the presence of a stalk connecting the intra-mural radial artery mass to the radiocarpal joint. The mass and stalk were excised en bloc with fenestration of the volar capsule to prevent recurrence. This case demonstrates a less common example of upper extremity adventitial cystic disease and supports the articular theory of origin of these lesions. When surgical excision is performed, an attempt should be made to identify and excise the articular stalk in an effort to minimize risk of recurrence.
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Affiliation(s)
- Natalie H Vaughn
- * Departments of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Donald J Flemming
- † Departments of Radiology, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jordan M Newell
- ‡ Departments of Anatomic Pathology, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Alexander H Payatakes
- * Departments of Orthopaedics and Rehabilitation, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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26
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Lewallen LW, Spinner RJ, Amrami KK, Kakar S. Adventitial cysts of the radial artery are joint connected. Clin Anat 2018; 32:201-205. [DOI: 10.1002/ca.23271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Laura W. Lewallen
- Department of OrthopedicsMayo Clinic, Division of Hand Surgery Rochester Minnesota
| | - Robert J. Spinner
- Department of OrthopedicsMayo Clinic, Division of Hand Surgery Rochester Minnesota
- Department of NeurosurgeryMayo Clinic Rochester Minnesota
| | | | - Sanjeev Kakar
- Department of OrthopedicsMayo Clinic, Division of Hand Surgery Rochester Minnesota
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27
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García García F, Pescador Hernández D, Rendon Díaz D, Blanco Blanco J. Intraneural ganglion cyst of the external popliteal sciatic nerve: A possible cause of foot drop. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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28
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Spinner RJ, Wolanskyj-Spinner AP. Retracing the observations and footsteps of Beauchêne fils: A blueprint for scientific research. Clin Anat 2018; 31:1194-1198. [PMID: 30117198 DOI: 10.1002/ca.23258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/12/2022]
Abstract
Throughout the years, scientific and personal research has led us on a historical journey to learn about the life of Beauchêne fils (Edme François Chauvot de Beauchêne), a French clinical anatomist, prosector, and surgeon responsible for introducing the disarticulated skull technique and the first citation of an intraneural cyst. This letter describes our research, travels, and conversations intended to uncover the fascinating history of Beauchêne fils and his family and our journey full of unexpected twists and turns. During a trip to Paris, we learned of a possible inspiration for the disarticulated skull technique from skulls afflicted with la teigne (Tinea corporis, ring worm) at the Musée Dupuytren. We toured the estate of his family's summer home in Paron, France, where we discovered a portrait of Beauchêne fils' father that had been misidentified in our recent publication. We also discovered the date of death and elusive burial site of Beauchêne fils in Père Lachaise cemetery in Paris. We hope to bring to light the life and contributions of a nearly unknown figure who influenced not only research on intraneural ganglion cysts and the articular theory, but also the future of the field of anatomy. Clin. Anat. 31:1194-1198, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
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29
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Abstract
Adventitial cystic disease (ACD) of the radial artery is a rare condition, with few cases described in the literature. We report the case of a 62-year-old white male with a history of diabetes, hypertension, and chronic kidney disease with indications for renal replacement therapy who was found to have a cystic lesion of the radial artery while undergoing surgical creation of an arteriovenous fistula. The surgical technique adopted was resection of the cystic segment and preservation of the radial artery. Fistula creation was completed successfully. Early diagnosis and appropriate treatment of ACD are effective, and can prevent complications and recurrence.
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30
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Kim HK, Park S, Hwang D, Huh S. Adventitial Cystic Disease of the Iliac Artery with a Connection to the Hip Joint. Vasc Specialist Int 2018; 34:10-13. [PMID: 29629360 PMCID: PMC5880339 DOI: 10.5758/vsi.2018.34.1.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/21/2017] [Accepted: 01/07/2018] [Indexed: 11/20/2022] Open
Abstract
More than 700 adventitial cystic diseases (ACDs) have been reported in the literature, with most cases affecting the popliteal artery in young men. Here, we describe our treatment and etiologic consideration of a patient who presented with an ACD of the external iliac artery, known to be an extremely rare location. On preoperative imaging, the ACD had a connection to the nearby hip joint and was treated with resection of the affected segment, including ligation of the joint connection and interposition with a prosthetic graft. The pathogenesis of ACDs is not fully understood; however, we believe that joint connections are important in their development and treatment.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sujin Park
- Division of Vascular Surgery, Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Deokbi Hwang
- Division of Vascular Surgery, Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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31
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Spinner RJ, Capek S. Adapting Findings From Rare Peripheral Nerve Disorders Can Lead to Broad Applications in Neurosurgery. Neurosurgery 2017; 64:52-58. [DOI: 10.1093/neuros/nyx306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/09/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Stepan Capek
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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32
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Adventitial cystic disease of radial artery. Apropos of a case and review of literature. Cardiovasc Pathol 2017; 29:33-36. [DOI: 10.1016/j.carpath.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022] Open
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33
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Masaki N, Yajima N, Ogasawara T, Kawarai SI, Matsuki K. Adventitial Cystic Disease Communicating with the Knee Joint: A Case Report with Histopathological Study of the Connection. Ann Vasc Surg 2017; 44:415.e7-415.e10. [PMID: 28483621 DOI: 10.1016/j.avsg.2017.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/26/2017] [Indexed: 11/19/2022]
Abstract
Adventitial cystic disease is a rare nonatheromatous cause of popliteal artery disease. Here, we present a case of a 51-year-old male patient who presented with right calf claudication caused by adventitial cystic disease. Preoperative magnetic resonance imaging and intraoperative findings revealed the presence of a connection between the cyst and adjacent knee joint. In addition, histopathological examination revealed that the tissue structure of the connection was similar to that of adventitial cysts. The tissue composed of 2 types of cells, namely macrophages and fibroblast-like cells, and lesional cells expressed D2-40. These findings supported the ganglion theory as the underlying physiopathology of this disease and were helpful in deciding the management of this case.
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Affiliation(s)
- Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Nobuhisa Yajima
- Department of Pathology and Laboratory Medicine, Hachinohe City Hospital, Hachinohe, Aomori, Japan
| | - Takashi Ogasawara
- Department of Cardiovascular Surgery, Hachinohe City Hospital, Hachinohe, Aomori, Japan
| | - Shun-Ichi Kawarai
- Department of Cardiovascular Surgery, Hachinohe City Hospital, Hachinohe, Aomori, Japan
| | - Katsuo Matsuki
- Department of Cardiovascular Surgery, Hachinohe City Hospital, Hachinohe, Aomori, Japan
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34
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Intraneural ganglion cyst of the external popliteal sciatic nerve: A possible cause of foot drop. Neurologia 2017; 33:486-489. [PMID: 28427770 DOI: 10.1016/j.nrl.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/29/2017] [Accepted: 02/04/2017] [Indexed: 01/12/2023] Open
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35
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Motaganahalli RL, Smeds MR, Harlander-Locke MP, Lawrence PF, Fujimura N, DeMartino RR, De Caridi G, Munoz A, Shalhub S, Shin SH, Amankwah KS, Gelabert HA, Rigberg DA, Siracuse JJ, Farber A, Debus ES, Behrendt C, Joh JH, Saqib NU, Charlton-Ouw KM, Wittgen CM. A multi-institutional experience in adventitial cystic disease. J Vasc Surg 2017; 65:157-161. [DOI: 10.1016/j.jvs.2016.08.079] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
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36
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Prasad N, Wolanskyj AP, Amrami KK, Spinner RJ. Clinical anatomy leading the way for solutions: An important paradigm for translational research. Clin Anat 2016; 29:978-979. [PMID: 27576851 DOI: 10.1002/ca.22782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/26/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Nikhil Prasad
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kimberly K Amrami
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.,Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Kim HK, Hwang D, Park S, Jeong WJ, Seo AN, Huh S. Cystic Disease of the Groin Presenting as Compression of a Femoral Vessel. Vasc Specialist Int 2016; 32:124-128. [PMID: 27699160 PMCID: PMC5045255 DOI: 10.5758/vsi.2016.32.3.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 12/25/2022] Open
Abstract
In this study, we describe our diagnosis and treatment of two patients who presented with femoral vessel compression caused by a cystic lesion in the groin. One case was diagnosed as adventitial cystic disease (ACD) of the common femoral artery resulting in leg claudication and the other was diagnosed as a ganglion cyst (GC) causing femoral vein compression and unilateral leg swelling. The operative findings differed between these two cases with respect to the dissection of the cyst and femoral vessel, but the postoperative histological examination results were similar. The pathogenesis of ACD and GC is not fully understood, and further investigation is needed to delineate the exact pathology of these uncommon conditions.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Deokbi Hwang
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sujin Park
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won-Ju Jeong
- Department of Orthopedic Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - An Na Seo
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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Warhadpande S, Go MR, El Sayed H, Satiani B, Vaccaro PS. Popliteal Artery Cystic Adventitial Disease: Early Lessons in Treatment. Ann Vasc Surg 2016; 38:255-259. [PMID: 27531095 DOI: 10.1016/j.avsg.2016.05.112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/21/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We present 6 patients who had operative repair of symptomatic popliteal cystic adventitial disease (pCAD). Developmental theories for pCAD and surgical alternatives are presented. METHODS All patients who had repair of pCAD over the past 3 years are included. RESULTS Three patients had cyst excision alone, whereas the remaining 3 had cyst and artery excision with interposition vein grafting. Cyst recurrence occurred in 2 patients who had cyst excision alone. Four of the patients had a patent communication between the cyst and the joint capsule. CONCLUSIONS Our small series suggests that the articular (synovial) theory of development may be the most likely and that cyst and artery excision with interposition vein grafting may be preferred over cyst excision alone.
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Affiliation(s)
- Shantanu Warhadpande
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Michael R Go
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hosam El Sayed
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bhagwan Satiani
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Patrick S Vaccaro
- Division of Vascular Diseases and Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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Niizeki T, Ishino M, Kitahara T, Yamauchi S, Ikeno E, Kubota I. A Case of Cystic Adventitial Degeneration of the Left Popliteal Artery Diagnosed by Intravascular Ultrasound. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:11-4. [PMID: 26949345 PMCID: PMC4772905 DOI: 10.4137/ccrep.s38175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 11/17/2022]
Abstract
An 87-year-old male was admitted with intermittent claudication of the left calf. We performed lower extremity angiography, which revealed stenosis of the left popliteal artery. Intravascular ultrasound (IVUS) image correctly identified the cystic appearance of visualized extravascular hypodensity, causing extrinsic compression of the lumen. We diagnosed the condition as cystic adventitial degeneration (CAD) of the popliteal artery. We operated a resection of a cyst with the artery and replaced the autovein graft (saphenous vein). After surgery, the patient was free of symptoms. CAD is a rare disease; thus, our IVUS findings may provide unique diagnostic clues in patients with CAD.
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Mitsunori Ishino
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Tatsuro Kitahara
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - So Yamauchi
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Eiichiro Ikeno
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Isao Kubota
- First Department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan
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40
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Desy NM, Wang H, Elshiekh MAI, Tanaka S, Choi TW, Howe BM, Spinner RJ. Intraneural ganglion cysts: a systematic review and reinterpretation of the world's literature. J Neurosurg 2016; 125:615-30. [PMID: 26799306 DOI: 10.3171/2015.9.jns141368] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. METHODS In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004-2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. RESULTS In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation of published cases and 16 of 16 cases from their sampling of original MR images from published cases. Overall, joint connections were more commonly found in patients who received an MRI examination and were more frequently reported during the years 2004 to 2015 (statistically significant difference for both). CONCLUSIONS This comprehensive review of the world's literature and the MR images further supports the articular (synovial) theory and provides baseline data for future investigators.
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Affiliation(s)
| | | | | | - Shota Tanaka
- Department of Neurosurgery, Faculty of Medicine, The University of Tokyo, Japan; and
| | - Tae Woong Choi
- Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Republic of Korea
| | | | - Robert J Spinner
- Departments of 2 Neurologic Surgery.,Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
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42
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Surgical Treatment of Cystic Adventitial Disease of the Popliteal Artery: Five Case Reports. Case Rep Vasc Med 2015; 2015:984681. [PMID: 26339520 PMCID: PMC4539061 DOI: 10.1155/2015/984681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 07/26/2015] [Indexed: 11/17/2022] Open
Abstract
Cystic adventitial disease (CAD) is a rare cause of intermittent claudication and nonatherosclerotic conditions in middle-aged men without cardiovascular risk factors. The etiology of CAD is unclear; however, the direct communication between a cyst and a joint is presumed to be a cause. We herein report a case series of CAD of the popliteal artery (CADPA), in which patients were treated with surgical resection and vascular reconstruction. Although less invasive treatment modalities, including percutaneous cyst aspiration and percutaneous transluminal angioplasty, have been the subject of recent reports, these treatments have had a higher recurrence rate. Therefore, all of the CAPDA cases in the present series were treated surgically, which lead to good outcomes.
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Prasad N, Amrami KK, Winn J, Spinner RJ. Cystic adventitial disease in the popliteal artery with a joint connection to the superior tibiofibular joint: Radiological evidence to support the unifying articular theory. Clin Anat 2015; 28:957-9. [PMID: 26296389 DOI: 10.1002/ca.22616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 08/05/2015] [Accepted: 08/15/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Nikhil Prasad
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Justin Winn
- Department of Radiology, University of Connecticut Health Center, Farmington, Connecticut
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Prasad NK, Howe BM, Amrami KK, Spinner RJ. An anatomic explanation for combined so-called adventitial/intraneural cysts. Clin Anat 2015; 28:829-32. [PMID: 25864719 DOI: 10.1002/ca.22538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 02/25/2015] [Accepted: 02/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Nikhil K Prasad
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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45
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Prasad NK, Desy NM, Amrami KK, Spinner RJ. How to explain cystic adventitial disease coexisting in an adjacent artery and vein. Clin Anat 2015; 28:833-5. [PMID: 25644633 DOI: 10.1002/ca.22506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Nikhil K Prasad
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Nicholas M Desy
- Department of Orthopedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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47
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Kauffman P, Kuzniec S, Sacilotto R, Teivelis MP, Wolosker N, Tachibana A. Cystic adventitial disease of the popliteal artery: an infrequent cause of intermittent claudication. ACTA ACUST UNITED AC 2014; 12:358-60. [PMID: 25167336 PMCID: PMC4872951 DOI: 10.1590/s1679-45082014rc2818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 12/06/2013] [Indexed: 11/22/2022]
Abstract
Intermittent claudication is frequently associated with atherosclerotic disease, but differential diagnosis must be sought in patients with no traditional risk factors. Cystic adventitial disease, of unknown etiology, most frequently affects the popliteal artery, and occasionally presents as intermittent claudication. We report a case of this disease and the surgical treatment, and discuss some aspects related to etiopathogenesis, diagnosis and treatment of this condition.
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Affiliation(s)
- Paulo Kauffman
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Sergio Kuzniec
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Roberto Sacilotto
- Instituto de Assistência Médica ao Servidor Público Estadual "Francisco Morato de Oliveira", São Paulo, SP, Brasil
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48
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Desy NM, Spinner RJ. The etiology and management of cystic adventitial disease. J Vasc Surg 2014; 60:235-45, 245.e1-11. [DOI: 10.1016/j.jvs.2014.04.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/06/2014] [Indexed: 12/20/2022]
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49
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Rendon D, Pescador D, Cano C, Blanco J. Intraneural ganglion cyst on the external popliteal nerve. BMJ Case Rep 2014; 2014:bcr-2013-201970. [PMID: 24891476 DOI: 10.1136/bcr-2013-201970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There are many causes for the paralysis of the external sciatic popliteal nerve , such as the intraneural ganglion cyst. In this case, we evaluate a 52-year-old woman with no relevant personal record, who was admitted with paresis of the right foot of 4 months of evolution associated with alterations in the sensitivity that rose up to the posterolateral region of the leg. The diagnosis was based on MR and cyst decompression and disconnection of the articular branch. Given the low incidence of these lesions, their origin is still subject to controversy. The most widely accepted theory is the unifying articular theory described by Spinner in the year 2003. Intraneural ganglion cysts must be included in the differential diagnosis of progressive paralysis of the sciatic nerve, lesions of the nerve root at L5 and nerve sheath tumours that start at the lateral compartment of the knee. The treatment of a fibular intraneural ganglion cyst must be surgical and the operation must be performed as soon as possible.
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Affiliation(s)
- Diego Rendon
- Orthopedic Department, University Hospital of Salamanca, Salamanca, Spain
| | - David Pescador
- Orthopedic Department, University Hospital of Salamanca, Salamanca, Spain
| | - Carlos Cano
- Orthopedic Department, University Hospital of Salamanca, Salamanca, Spain
| | - Juan Blanco
- Orthopedic Department, University Hospital of Salamanca, Salamanca, Spain
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Hao H, Ishibashi-Ueda H, Nishida N, Kawakami R, Tsukamoto Y, Tsujimoto M, Hirota S. Distribution of myofibroblast and tenascin-C in cystic adventitial disease: Comparison with ganglion. Pathol Int 2014; 63:591-8. [DOI: 10.1111/pin.12119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/14/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Hiroyuki Hao
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Naoki Nishida
- Department of Pathology; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Rika Kawakami
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Yoshitane Tsukamoto
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | | | - Seiichi Hirota
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
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