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Miyauchi E, Okui H, Yuasa T, Oketani N, Ohishi M. Adventitial Cystic Disease in the Popliteal Artery Diagnosed by Intravascular Ultrasound Imaging. Cureus 2023; 15:e34362. [PMID: 36874647 PMCID: PMC9975419 DOI: 10.7759/cureus.34362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
The prevalence of peripheral artery disease (PAD) has been increasing in parallel with the increasing prevalence of the atherosclerotic disease. Therefore, we have to be familiar with the diagnostic approach used for ischemic symptoms in the lower limbs. Adventitial cystic disease (ACD) is rare but not negligible as one of the differential diagnoses of intermittent claudication (IC). Although duplex ultrasound and magnetic resonance imaging (MRI) are helpful tools for the diagnosis of ACD, further imaging modality is needed to avoid misdiagnosis. A 64-year-old man with a mitral valve prosthesis presented to our hospital with a one-month history of IC in the right calf after walking for approximately 50 meters. On physical examination, the pulse in the right popliteal artery was not palpable, nor were the dorsal pedis artery and posterior tibial artery, although there were no other symptoms of ischemia. His right ankle-brachial index (ABI) was 1.12 at rest but decreased to 0.50 after exercise. Three-dimensional computed tomography (CT) angiography revealed a severe stenotic lesion approximately 70 mm long in the right popliteal artery. Therefore, we diagnosed PAD in the right lower limb and planned endovascular therapy. The stenotic lesion was markedly reduced on catheter angiography when compared with CT angiography. However, intravascular ultrasound (IVUS) detected little atherosclerosis and cystic lesions within the wall in the right popliteal artery that did not involve the arterial lumen. Especially, IVUS clearly demonstrated that the crescent-shaped cyst compressed the arterial lumen eccentrically and other cysts surrounded the lumen circumferentially like petals. Because IVUS revealed these cysts to be extravascular structures, the patient was subsequently thought to have ACD of the right popliteal artery. Fortunately, his cysts reduced in size spontaneously and his symptoms disappeared. We have monitored the patient's symptoms, ABI, and findings on duplex ultrasound for seven years, during which there has been no recurrence. In this case, we diagnosed ACD in the popliteal artery by IVUS rather than duplex ultrasound and MRI.
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Affiliation(s)
- Eiji Miyauchi
- Division of Cardiology, Kagoshima City Hospital, Kagoshima, JPN
| | - Hideki Okui
- Division of Cardiology, Kagoshima City Hospital, Kagoshima, JPN
| | | | - Naoya Oketani
- Division of Cardiology, Kagoshima City Hospital, Kagoshima, JPN
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima, JPN
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Hariri O, Al Laham O, Alderi Y, Nahas MA. A remarkably rare case of Adventitial Cystic Disease of the Popliteal Artery in a 51-year-old Middle Eastern female - A Case Report. Int J Surg Case Rep 2022; 101:107811. [PMID: 36462233 PMCID: PMC9718994 DOI: 10.1016/j.ijscr.2022.107811] [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: 10/01/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Adventitial Cystic Disease (ACD) is a vastly rare non-atherosclerotic vascular pathology that is principally manifested as intermittent claudication because of peripheral vascular ischemia. Precise etiological factors are not yet concretely identified, and it represents 0.1 % of all lower limb claudication causes. Middle-aged males are the most affected gender age group. Misdiagnosis of Popliteal Artery ACD could delay proper management and hence risk the loss of the affected limb due to critical limb ischemia. CASE PRESENTATION We hereby explore the rare case of a 51-year-old female patient, who complained of vague left lower extremity pain accompanied by paresthesia for 1 month prior to admission without signs of local inflammation. The preoperative radiological assessment suggested the presence of thrombosis within the left Popliteal Artery which caused an occlusion in it and hence the proper blood flow was compromised. CLINICAL DISCUSSION Surgical intervention and the complete removal of the lesion along with establishing a patent synthetic anastomotic graft to maintain the preexisting vascular bundle was the key to treating our patient. Microscopic analysis of the excised specimen revealed an Adventitial Cystic Disease of the Popliteal Artery. CONCLUSION Adventitial Cystic Disease represents an extremely rare vascular pathology with a vast margin of non-specific symptoms that could lead to misdiagnoses. It is fundamental to establish suitable preoperative screening protocols for it and sustain adequate levels of clinical awareness so that we can timely diagnose and in turn, achieve proper therapeutic interventions to plummet the potential disastrous complications that could ensue.
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Affiliation(s)
- Omar Hariri
- Al-Mouwasat University Hospital, Damascus, Syria,Al Assad University Hospital, Damascus, Syria,Faculty of Medicine, Damascus University, Damascus, Syria
| | - Omar Al Laham
- Faculty of Medicine, Damascus University, Damascus, Syria,Corresponding author.
| | - Yaman Alderi
- Al Assad University Hospital, Damascus, Syria,Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohamad-Ali Nahas
- Al Assad University Hospital, Damascus, Syria,Faculty of Medicine, Damascus University, Damascus, Syria,Head of Division of Vascular and Endovascular Surgery, Al Assad Damascus University Hospital, Damascus, Syria
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3
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Konda S, Reed AB. Popliteal artery adventitial cystic disease in an athlete. J Vasc Surg Cases Innov Tech 2022; 8:140-141. [PMID: 35330899 PMCID: PMC8938193 DOI: 10.1016/j.jvscit.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022] Open
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Yoon JW, Choi W, Kim SM, Hur J. Treatment failure after rotational atherectomy and balloon angioplasty in recurrent cystic adventitial disease of the popliteal artery: a case report. J Int Med Res 2022; 50:3000605221086149. [PMID: 35301877 PMCID: PMC8943312 DOI: 10.1177/03000605221086149] [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] [Indexed: 11/25/2022] Open
Abstract
Cystic adventitial disease (CAD), which usually affects the popliteal artery, is a rare vascular condition in which fluid accumulates in the sub-adventitial layer, compressing the lumen. Historically, surgical treatment is preferred over endovascular or minimally invasive techniques, due to its lower recurrence rates. Here, the case of a 67-year-old male patient, in whom rotational atherectomy was performed for recurrent CAD following surgical cyst excision and patch angioplasty is reported. The patient’s symptoms recurred one day after the rotational atherectomy procedure and repeat computed tomography angiography showed recurrence of the disease. Due to gradual worsening of the condition during 8 months of follow-up, left distal femoral artery to popliteal artery (below-the-knee) bypass surgery was performed using an ipsilateral reversed great saphenous vein graft. Follow-up has continued for 2 years without complications or requirement of additional treatment. This novel case is the first report of atherectomy attempted for recurrent CAD that led to an early recurrence. Our experience emphasises that additional surgical approaches should be selected over endovascular procedures for treating recurrent CAD.
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Affiliation(s)
- Jin Woo Yoon
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Woosun Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Suh Min Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
| | - Joonho Hur
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Republic of Korea
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Tanaka S, Tanaka K, Okazaki J. Cystic Adventitial Disease of the Popliteal Artery With Recurrent Intermittent Claudication After Drug-Coating Balloon Angioplasty: A Case Report Treated by Surgical Treatment. Cureus 2022; 14:e23190. [PMID: 35444903 PMCID: PMC9009971 DOI: 10.7759/cureus.23190] [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] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Cystic adventitial disease of the popliteal artery is a rare cause of unilateral intermittent claudication. The etiology of cystic adventitial disease is unknown, and affected patients are younger than those diagnosed with chronic arteriosclerosis. A 62-year-old man presented with a history of right leg claudication, which occurred after walking a distance of 500 m. The patient had no history of cardiovascular risk factors or trauma in the lower extremities. The ankle-brachial pressure index (ABI) was 0.58 in the affected leg. The patient was referred to the cardiovascular department. On Doppler ultrasonography, popliteal artery stenosis was detected. Following an angiogram, drug-coated balloon angioplasty was performed. The claudication improved, as indicated by an ABI of 1.11 in the affected leg. However, following one month of endovascular treatment, claudication had recurred, indicated by an ABI of 0.59. Computed tomography indicated the presence of a stenotic lesion in the popliteal artery, which may have developed from compression on the artery due to the presence of a surrounding periarterial cyst. The patient was subsequently diagnosed with cystic adventitial disease of the popliteal artery and was referred for vascular surgery. During surgery, the popliteal artery was exposed by the posterior approach; the artery showed circumferential enlargement and complete resection of the adventitial layer was performed. The patient had a successful postoperative recovery and the claudication disappeared (ABI of 1.14). Surgical management is an effective curative treatment for cystic adventitial disease of the popliteal artery that shows better efficacy than endovascular treatment. In the future, diagnostic methods for cystic adventitial disease should include computed tomography or magnetic resonance imaging with T1- and T2-weighted images.
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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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Tayeh M, Galkin P, Majd P. Claudication due to adventitial cystic degeneration: A differential diagnosis of peripheral artery disease. Vascular 2022; 31:589-593. [PMID: 35000516 DOI: 10.1177/17085381211068723] [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: 11/15/2022]
Abstract
BACKGROUND Cystic adventitial disease (CAD) is an important and rare non-atherosclerotic cause of intermittent claudication and critical limb ischemia. Since the first case of CAD involving the external iliac artery was described by Atkins and Key in 1947, approximately 300 additional cases have been reported. OBJECTIVES The aim of this article is to report a rare vascular disorder, predominantly seen in young healthy men with minimal cardiovascular risk factors. METHODS We report a rare case of cystic adventitial disease of a young policeman. To confirm the diagnosis, an ultrasonography and a conventional angiography were performed. The therapeutic approach was surgical first. RESULTS The procedure was successful without any complication, and the patient was discharged to home 4 days after procedure. CONCLUSION While CAD is rare, the diagnosis should be suspected in a young patient who presents with arterial insufficiency and no risk factors for atherosclerosis. Catheter angiography is the investigation of choice in the absence of multislice CT and good MRA. It seems that the treatment that assures the best long-term results is reconstructive arterial bypass surgery.
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Affiliation(s)
- M Tayeh
- Vascular Surgery, 169386Evangelisches Krankenhaus Bergisch Gladbach, Bergisch Gladbach, Germany
| | - P Galkin
- Vascular Surgery, 169386Evangelisches Krankenhaus Bergisch Gladbach, Bergisch Gladbach, Germany
| | - P Majd
- Vascular Surgery, 169386Evangelisches Krankenhaus Bergisch Gladbach, Bergisch Gladbach, Germany
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Bai H, Wu H, Wang Z, Li M, Zhang Q, Song Y, Zhao T, Liu Y, Bai T. Nonatheromatous Popliteal Artery Disease. Ann Vasc Surg 2021; 79:139-144. [PMID: 34644658 DOI: 10.1016/j.avsg.2021.07.016] [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: 04/21/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Peripheral artery disease (PAD) is often caused by atherosclerosis. However, causes other than atherosclerosis is often overlooked. Popliteal artery entrapment syndrome (PAES) and popliteal artery adventitial cystic disease (PACD) are two common nonatheromatous causes of claudication and critical limb ischemia. The purpose of this study is to present early results of treatment of PAES and PACD involving the lower limbs. METHODS From December 2019 to February 2021, 10 patients with PAES underwent surgeries, and 1 patient with PAES received conservative treatment. 2 patients with PACD underwent surgery. Patient data including age, gender, etiology of vascular pathology, diseased vessel, surgical method, and hemodynamic status were collected retrospectively. RESULTS The mean follow-up duration was 5.64 ± 3.72 months (range, 1-12 months). All patients had their symptoms improved or resolved. The success rate of surgery was 100%, the rate of freedom from reintervention for any reason was 100%. There were no death, bleeding, embolism, or skin ulcers during late follow-up. CONCLUSIONS PAES and PACD require early diagnosis and intervention, and early surgery may lead to good early- and mid-term results.
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Affiliation(s)
- Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China; Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, Henan, China.
| | - Haoliang Wu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Mingxing Li
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Qiang Zhang
- Department of Vascular Surgery, Anyang District Hospital, Henan, China; Department of Vascular Surgery, First Affiliated Hospital of Henan University of Science and Technology, Henan, China
| | - Yan Song
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Tiejun Zhao
- Department of Vascular Surgery, First Affiliated Hospital of Henan University of Science and Technology, Henan, China
| | - Yuanfeng Liu
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China; Department of Vascular Surgery, Anyang District Hospital, Henan, China
| | - Tao Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
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Tesar J, Moult V, Quinn S. Non-atherosclerotic cause of claudication: cystic adventitial disease of the popliteal artery. ANZ J Surg 2021; 91:E796-E797. [PMID: 33969613 DOI: 10.1111/ans.16920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/12/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Joshua Tesar
- Vascular Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Vivienne Moult
- Vascular Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Simon Quinn
- Vascular Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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10
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Jeong S, Kwon TW, Han Y, Cho YP. Effectiveness of Surgical Treatment with Complete Cyst Excision for Cystic Adventitial Disease of the Popliteal Artery. Ann Vasc Surg 2020; 72:261-269. [PMID: 32946995 DOI: 10.1016/j.avsg.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/23/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cystic adventitial disease is a rare, nonatherosclerotic disease that affects various arteries and veins, involving the formation of a mucinous cyst within the adventitia. The etiology of the cystic adventitial disease is currently unclear, with several hypotheses having been suggested. The purpose of this retrospective observational study was to evaluate the etiology of popliteal cystic adventitial disease based on imaging and surgical findings and to evaluate the efficacy of surgical treatment. METHODS From April 2013 to January 2020, nine patients were diagnosed with the popliteal cystic adventitial disease and underwent surgical treatment. We performed complete resection of the cyst and the affected segment of the popliteal artery, followed by interposition with autologous reversed small saphenous vein or great saphenous vein. RESULTS The resected adventitial cyst tissue was multilobular, filled with high-viscosity mucus. Pathologic examination of the surgical specimen revealed intramural cysts filled with gelatinous material located between the media and the adventitia, consistent with the clinical diagnosis of cystic adventitial disease. The median follow-up period was 27.5 months (range: 2-91 months). All patients underwent cyst excision with graft interposition, and the overall graft patency was 80.9 months (95% CI: 62.2-99.6 months). CONCLUSIONS Computed tomography, magnetic resonance imaging, and surgical findings confirmed communication between the synovial cyst and arterial adventitia. It is recommended that priority be given to surgical resection and graft interposition because this can eliminate the disease's cause and reduce its recurrence.
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Affiliation(s)
- Seonjeong Jeong
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Cystic adventitial disease of the popliteal artery. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:344-345. [PMID: 32715168 PMCID: PMC7371724 DOI: 10.1016/j.jvscit.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022]
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12
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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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Nemoto M, Hosaka A. Spontaneous Regression of Cystic Adventitial Disease of the Popliteal Artery: A Case Report. Ann Vasc Surg 2019; 62:498.e11-498.e13. [PMID: 31449954 DOI: 10.1016/j.avsg.2019.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Masaru Nemoto
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center, Kasama-shi, Ibaraki, Japan
| | - Akihiro Hosaka
- Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
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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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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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Jibiki M, Miyata T, Shigematsu H. Cystic adventitial disease of the popliteal artery with spontaneous regression. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:136-139. [PMID: 29942903 PMCID: PMC6012984 DOI: 10.1016/j.jvscit.2018.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/23/2018] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Masatoshi Jibiki
- Department of Vascular Surgery, International University of Health and Welfare, Shioya Hospital, Tochigi, Japan
| | - Tetsuro Miyata
- Department of Vascular Surgery, International University of Health and Welfare, Shioya Hospital, Tochigi, Japan.,Vascular Center, Sanno Medical Center, Tokyo, Japan
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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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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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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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Seo H, Fujii H, Aoyama T, Sasako Y. A Case of Adventitial Cystic Disease of the Popliteal Artery Progressing Rapidly after Percutaneous Ultrasound-guided Aspiration. Ann Vasc Dis 2014; 7:417-20. [PMID: 25593629 DOI: 10.3400/avd.cr.14-00097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 09/19/2014] [Indexed: 11/13/2022] Open
Abstract
Adventitial cystic disease is a rare non-atherosclerotic vascular disease. We report a 36-year-old man with right intermittent claudication by adventitial cystic disease. computed tomography (CT) and magnetic resonance imaging (MRI) revealed an ovoid cystic mass compressing the right popliteal artery and causing severe stenosis of the lumen. Percutaneous aspiration was performed, which improved his symptoms. However, he complained of identical intermittent claudication two weeks later. Radiographic findings revealed that the cystic lesion had progressed rapidly. The cystic lesion was resected and the affected arterial segment was interposed. We consider that conventional surgical intervention remains the favored treatment option in the management of adventitial cystic disease.
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Affiliation(s)
- Hiroyuki Seo
- Department of Cardiovascular Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Hiromichi Fujii
- Department of Cardiovascular Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Takanobu Aoyama
- Department of Cardiovascular Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Yoshikado Sasako
- Department of Cardiovascular Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
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Del Canto Peruyera P, Vázquez MJVV, Velasco MB, Álvarez PC, Salgado AÁ, Álvarez JC, Fernández LJÁ. Cystic adventitial disease of the popliteal artery: Two case reports and a review of the literature. Vascular 2014; 23:204-10. [PMID: 24986869 DOI: 10.1177/1708538114541652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two cases of cystic adventitial disease treated at our institution over the last year are presented. They were middle-aged and apparently healthy patients, and the symptoms begin with a sudden onset of unilateral claudication. After performing a magnetic resonance angiography, a cystic formation attached to the adventitia of the popliteal artery was identified. Both patients were treated in the same manner, with resection of the affected arterial segment and vein bypass interposition. Both remain asymptomatic after one year of follow-up in one case and six months in the other. Cystic adventitial disease is a rare entity, which presents in patients without cardiovascular risk factors, so sometimes it takes long to reach a definitive diagnosis. Concerning the different treatment options, cyst excision together with the affected arterial segment seems to offer better mid- and long-term results when compared with other treatment options such as cyst aspiration or endovascular techniques, although there are no multicenter trials evidencing the superiority of one against the others.
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Affiliation(s)
- P Del Canto Peruyera
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | | | - M Botas Velasco
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - P Calvín Álvarez
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - A Álvarez Salgado
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - J Cerviño Álvarez
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - L J Álvarez Fernández
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
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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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