Spontaneous Resolution of Cystic Adventitial Disease: A Word of Caution

Cystic Adventitial Disease of the Common Femoral Vein Presenting with Lower Limb Swelling: A Case Report

Cystic adventitial disease (CAD) is a rare vascular disorder predominantly seen in adults without cardiovascular risk factors. We report a case of CAD involving the common femoral vein in a 38-year-old female presented with right lower extremity swelling that was initially misdiagnosed as deep vein thrombosis (DVT). A computed tomography revealed a cystic structure that compressed the right common femoral vein with resultant severe stenosis of the vascular lumen. Complete evacuation of the cyst with excision of the cyst wall was performed, and the patient remained symptom-free at 3 year follow-up. This case highlighted that the rare venous CAD should be incorporated in the differential diagnosis of unilateral lower extremity swelling suspicious for a DVT. Complete evacuation and surgical excision of the cyst often conferred favorable clinical outcome.

Cystic adventitial disease of the popliteal artery with unusual spontaneous regression: A case report with literature review

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.

Spontaneous Resolution of Cystic Adventitial Disease of the Popliteal Artery

Spontaneous resolution of cystic adventitial disease (CAD) is rare with occasional reports in the literature. In this case report, we are describing a 30-year-old man who presented with rapid onset of severe intermittent claudication and was diagnosed with CAD. Resection of the lesion with autologous vein replacement was scheduled. However, the claudication suddenly improved at 4 weeks after onset. Ultrasonography and computed tomography revealed regression of the cystic lesions with resolution of the popliteal artery stenosis. His symptoms did not recur during the 12-month follow-up period. Although it is unclear whether this resolution is permanent, in this report, we describe our experience with a case of CAD that eventually spontaneously regressed and the possibility of conservative treatment.

Surgical Strategy to Reduce the Recurrence of Adventitial Cystic Disease after Treatment

Purpose

Adventitial cystic disease (ACD) is a rare condition that causes intermittent claudication and non-atherosclerotic disease without cardiovascular risk factors. The etiology and optimal treatment of ACD remain controversial. The purpose of this study was to analyze surgical treatment results for ACD and to elucidate optimal treatment options.

Materials and Methods

We retrospectively reviewed 30 patients with ACD who underwent surgery from 2006 to 2018. Twenty-two patients had arterial ACD, six had venous ACD, and two had combined venous and arterial ACD. We reviewed demographic and clinical characteristics, treatment details, and procedure outcomes.

Results

Recurrence occurred in 6 cases either after cyst excision alone (4/17) or patch angioplasty (2/2). There was no recurrence after vessel excision with interposition grafting (0/7). Therefore, vessel excision was a statistically significant factor in recurrence prevention (P=0.026). Among the six recurrences, joint connections of the cystic lesions were found in four of the six (66.7%).

Conclusion

As a curative surgery for ACD, vessel excision with interposition grafting is a better strategy to prevent recurrence than simple cyst excision alone.

Spontaneous Regression of Cystic Adventitial Disease of the Popliteal Artery: A Case Report

Spontaneous regression of cystic adventitial disease (CAD) of the popliteal artery is rare. In this report, we describe a 53-year-old woman who presented with left calf pain and was diagnosed with CAD with popliteal artery stenosis, which regressed without therapy. The disease was diagnosed via computed tomography, and a surgical intervention was planned at the time of diagnosis. However, her symptoms disappeared 2 months after the initial presentation. Ultrasonography and computed tomography revealed spontaneous regression of the cystic lesions and resolution of the popliteal artery stenosis. During the 29-month follow-up period, her symptoms did not recur. Although CAD often requires surgical intervention, it may be acceptable to carefully observe patients with spontaneous regression for some time to check for recurrence.

CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY

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.

Cystic adventitial disease of the popliteal artery with spontaneous regression

Cystic adventitial disease (CAD) of the popliteal artery with spontaneous regression is rare. We describe a 44-year-old man with rapid onset of severe intermittent claudication who is currently undergoing conservative follow-up. CAD was diagnosed, and resection of the lesion with autologous vein replacement was scheduled. However, the claudication suddenly improved at 5 weeks after onset. Computed tomography and ultrasound revealed that the cystic lesion in the adventitia had nearly disappeared. This case report describes the imaging findings and the possibility of conservative treatment. CAD can occur in the popliteal artery and is usually treated surgically. However, reports of spontaneous regression are rare. We report our experience with a case of CAD that eventually spontaneously regressed.

Doença cística adventicial da artéria poplítea: relato de caso

A doença cística adventicial da artéria poplítea é uma doença pouco frequente, que deve ser considerada no diagnóstico diferencial de pacientes jovens com claudicação intermitente e sem fatores de risco para doença arterial periférica aterosclerótica. Apresentamos um caso de claudicação intermitente de membros inferiores em paciente masculino de 51 anos no qual essa doença foi diagnosticada. Foi submetido a ressecção do segmento de artéria comprometido e interposição de safena autóloga ipsilateral. Discutimos alternativas diagnósticas e terapêuticas.

Surgical Treatment of Cystic Adventitial Disease of the Popliteal Artery: Five Case Reports

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.

Cystic Adventitial Disease of the Common Femoral Vein

We report on a 52-year-old female patient who presented with a 6-month history of right lower extremity swelling and tenderness. The patient was treated as an outpatient with full anticoagulation, without any improvement. Her medical history was significant for hypertension and high cholesterol, and she had a full coagulopathy profile that was negative for any hypercoagulable syndrome. On examination, the patient was moderately obese, with significant tenderness over the medial aspect of the right groin. A venous duplex examination revealed hypoechoic structure ± acute deep vein thrombosis of right common femoral vein (CFV). A computed tomography of the venous phase revealed an eccentric compression over the medial wall of the right CFV. During surgical exploration, adventitial cystic mucinous disease was enucleated from the medial wall of the right CFV, and the pathological examination confirmed the diagnosis. The postoperative course was uneventful, and all swelling and tenderness were completely resolved. The patient continued to do well, and she had an unremarkable venous duplex evaluation at her 6-month follow-up.

Cystic adventitial disease of popliteal artery with significant stenosis

Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein.