1
|
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.
Collapse
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
| |
Collapse
|
2
|
Liu Y, Wang Q, He C. Cystic Adventitial Disease of the Common Femoral Vein Presenting with Lower Limb Swelling: A Case Report. Vasc Endovascular Surg 2023:15385744231165991. [PMID: 36938599 DOI: 10.1177/15385744231165991] [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: 03/21/2023]
Abstract
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.
Collapse
Affiliation(s)
- Yang Liu
- Department of Vascular Surgery, 176759Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qiqi Wang
- Department of Vascular Surgery, 176759Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chunshui He
- Department of Vascular Surgery, 176759Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Zheng K, Yang W, Ren H, Wang S, Sun M, Zhang W, Li C. Compression syndromes of the popliteal artery due to intramuscular ganglion cyst of the biceps femoris: A case report and literature review. Front Cardiovasc Med 2022; 9:1018694. [PMID: 36505376 PMCID: PMC9732263 DOI: 10.3389/fcvm.2022.1018694] [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] [Received: 08/13/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Intramuscular ganglion cyst (IMGC) is a very rare lesion with an unidentified pathogeny that originates within the muscle. We encountered a case of 49-year-old man who complained of intermittent claudication in the right lower limb for 2 months. An intramuscular ganglion cyst in the biceps femoris muscle was diagnosed and located by Computed tomography angiography (CTA) and magnetic resonance imaging (MRI), which compressed the popliteal artery and resulted in ischemia in the right lower limb. Six months after surgical resection, there was no recurrence of the cyst and the popliteal artery was patency. We describe this case with a review of the relevant literature.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| | | | | |
Collapse
|
10
|
Yoo YS, Choi YD, Lee HK. Adventitial Cystic Disease of the Superficial Femoral Vein without a Joint Connection: A Case Report. Vasc Specialist Int 2021; 37:15. [PMID: 34168097 PMCID: PMC8236340 DOI: 10.5758/vsi.210034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/20/2022] Open
Abstract
Adventitial cystic disease (ACD) of the veins is a rare vascular disease. Most cases of venous ACD are located adjacent to the joint area, such as the common femoral, external iliac, and popliteal veins. To the best of our knowledge, 67 cases of venous ACD have been reported, and ACD of the superficial femoral vein (SFV) has never been reported. Herein, we report the case of a 57-year-old male who presented with swelling and discomfort in the left leg. Computed tomography venography revealed multiple cystic lesions in the left distal SFV. The patient underwent cyst excision, which relieved the compression in the vein, although mild stenosis prevailed in the SFV. After a week, thrombosis developed in the popliteal vein. The thrombosis resolved after three months of anticoagulant therapy, and the patient showed no recurrence of ACD during three years of follow-up.
Collapse
Affiliation(s)
- Young Sup Yoo
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Kyun Lee
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
11
|
Hashimoto M, Tamate Y, Sato H, Murakami A, Yanagawa N. Long-term outcome of partial resection in venous adventitial cystic disease. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:382-385. [PMID: 34278063 PMCID: PMC8261535 DOI: 10.1016/j.jvscit.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
Venous adventitial cystic disease is extremely rare. Therefore, standard treatment methods have not been clearly defined. Some reports suggest that complete cyst removal is an effective treatment. However, considering the relatively high recurrence rate, follow-up periods were short. Herein, we report the case of a 75-year-old man with venous adventitial cystic disease successfully treated with partial cyst wall excision. No recurrence was observed for 10 years postoperatively. This case suggests that complete cyst wall excision might not be necessary for the treatment of venous adventitial cystic disease.
Collapse
Affiliation(s)
- Munetaka Hashimoto
- Department of Vascular Surgery, Iwate Prefectural Isawa Hospital, Oshu, Iwate, Japan
| | - Yoshihisa Tamate
- Department of Vascular Surgery, Iwate Prefectural Isawa Hospital, Oshu, Iwate, Japan
| | - Hiroko Sato
- Department of Vascular Surgery, Iwate Prefectural Isawa Hospital, Oshu, Iwate, Japan
| | - Akihiko Murakami
- Department of Vascular Surgery, Iwate Prefectural Isawa Hospital, Oshu, Iwate, Japan
| | - Naoki Yanagawa
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
| |
Collapse
|
12
|
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
| |
Collapse
|
13
|
Spontaneous Resolution of Cystic Adventitial Disease of the Popliteal Artery. Case Rep Vasc Med 2021; 2021:8863682. [PMID: 33777475 PMCID: PMC7969084 DOI: 10.1155/2021/8863682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/24/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Schultz T. Ultrasound finding of cystic adventitial disease of the popliteal artery—A rare diagnosis for claudication. SONOGRAPHY 2020. [DOI: 10.1002/sono.12241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Teena Schultz
- The Vascular Institute, Bella Vista New South Wales Australia
| |
Collapse
|
16
|
Cai TY, Loa J. Multimodal imaging demonstrating adventitial cystic disease of the common femoral vein. ANZ J Surg 2020; 91:E330-E331. [PMID: 32997427 DOI: 10.1111/ans.16363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Tommy Y Cai
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacky Loa
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Lim JH, Chung BH, Kang JH, Heo SH, Kim DI, Kim YW, Park YJ. Surgical Strategy to Reduce the Recurrence of Adventitial Cystic Disease after Treatment. Vasc Specialist Int 2019; 35:217-224. [PMID: 31915666 PMCID: PMC6941769 DOI: 10.5758/vsi.2019.35.4.217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/17/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Ji-Ha Lim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong-Hoon Chung
- Department of Surgery, Chonbuk National University Hospital, Jeonju, Korea
| | - Ji-Hee Kang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seon-Hee Heo
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Wook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Mathiasen RE, Luo L, Norton A, Vargo C. Cystic Adventitial Disease of the Popliteal Artery in an Adult Male Soccer Player. Curr Sports Med Rep 2018; 17:287-289. [DOI: 10.1249/jsr.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
22
|
Iwasaki A, Furukawa K, Nakamura E, Nakamura K. Adventitial cystic disease of the common femoral vein misdiagnosed as deep vein thrombosis. Interact Cardiovasc Thorac Surg 2018; 27:312-313. [PMID: 29509904 DOI: 10.1093/icvts/ivy052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/02/2018] [Indexed: 11/12/2022] Open
Abstract
We report a case of venous adventitial cystic disease of the right common femoral vein, misdiagnosed as deep vein thrombosis before surgery in a 47-year-old woman who presented with swelling and heaviness in her right leg. Complete cyst wall resection and common femoral vein reconstruction via patch angioplasty were performed. The patient's postoperative course was uneventful.
Collapse
Affiliation(s)
- Ayaka Iwasaki
- Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan
| | - Koji Furukawa
- Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan
| | - Eisaku Nakamura
- Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan
| | - Kunihide Nakamura
- Department of Surgery, University of Miyazaki Hospital, Miyazaki, Japan
| |
Collapse
|
23
|
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.
Collapse
|
24
|
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.
Collapse
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
| | | |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Pursell R, Torrie EPH, Gibson M, Galland RB. Spontaneous and Permanent Resolution of Cystic Adventitial Disease of the Popliteal Artery. J R Soc Med 2017; 97:77-8. [PMID: 14749403 PMCID: PMC1079294 DOI: 10.1177/014107680409700208] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- R Pursell
- Department of Surgery, Royal Berkshire Hospital, Reading RG1 5AN, UK
| | | | | | | |
Collapse
|
27
|
Lezotte J, Le QP, Shanley C, Hans S. Adventitial Cystic Disease: Complicated and Uncomplicated. Ann Vasc Surg 2017; 46:370.e13-370.e15. [PMID: 28911964 DOI: 10.1016/j.avsg.2017.08.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
Three cases of adventitial cystic disease of popliteal artery are reported; 1 complicated with associated thrombosis of the popliteal artery and 2 uncomplicated. Operative management and follow-up are described.
Collapse
Affiliation(s)
- Jonathan Lezotte
- Department of Vascular Surgery, Henry Ford Health System, Detroit, MI.
| | - Quynh P Le
- Department of Vascular Surgery, Henry Ford Health System, Detroit, MI
| | - Charles Shanley
- Department of Vascular Surgery, Henry Ford Health System, Detroit, MI
| | - Sachinder Hans
- Department of Vascular Surgery, Henry Ford Health System, Detroit, MI
| |
Collapse
|
28
|
Hennessy MM, McGreal G, O'Brien GC. Two Cases of Popliteal Cystic Adventitial Disease Treated With Excision and Primary Bypass Graft: A Review of the Literature. Vasc Endovascular Surg 2017; 51:480-484. [PMID: 28859600 DOI: 10.1177/1538574417722921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cystic adventitial disease (CAD) is a rare vascular pathology which predominantly affects peripheral vessels of young otherwise healthy males. Much debate exists regarding its exact etiology. It is characterized by a collection of mucinous material within the adventitial wall layer of the affected vessel, resulting in arterial stenosis and rapidly progressive calf claudication. Treatment is primarily surgical, although radiological interventions have been reported. Its rarity makes evidence-based surgical or radiological management difficult. With this in mind, we report two cases of popliteal artery CAD treated successfully with primary excision and bypass grafting. We analyzed all literature published on CAD since first reported in 1947 and we propose an algorithm for appropriate management pathways.
Collapse
Affiliation(s)
- Mairead M Hennessy
- 1 Department of General and Vascular Surgery, Mercy University Hospital, Cork, Ireland
| | - Gerald McGreal
- 1 Department of General and Vascular Surgery, Mercy University Hospital, Cork, Ireland
| | - Gavin C O'Brien
- 1 Department of General and Vascular Surgery, Mercy University Hospital, Cork, Ireland
| |
Collapse
|
29
|
Li S, King BN, Velasco N, Kumar Y, Gupta N. Cystic adventitial disease-case series and review of literature. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:327. [PMID: 28861424 DOI: 10.21037/atm.2017.05.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cystic adventitial disease (CAD) is a rare vascular disorder that involves the arteries and rarely the veins, most commonly found in the popliteal artery of male patients. Etiology of CAD is uncertain and currently without a consensus agreement. Clinically, the most common presenting symptom is claudication. Diagnosis requires a strong clinical suspicion in patients with intermittent claudication, but without other risk factors for atherosclerotic disease. Angiography, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used for diagnosis. Treatment of CAD can be done via surgical resection or percutaneous intervention such as aspiration. CAD can rarely recur after treatment.
Collapse
Affiliation(s)
- Shuo Li
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA
| | - Brian N King
- Department of Surgery, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA
| | - Noel Velasco
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA
| | - Nishant Gupta
- Department of Radiology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, CT, USA
| |
Collapse
|
30
|
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
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Peripheral Non-atherosclerotic Arterial Disorders: What Radiologists Need to Know. Acad Radiol 2017; 24:497-505. [PMID: 27940229 DOI: 10.1016/j.acra.2016.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 12/24/2022]
Abstract
Peripheral non-atherosclerotic arterial disorders (NAADs) are a heterogeneous group of rather uncommon conditions that tend to manifest in subjects without atherosclerosis. Each of these conditions has distinctive pathophysiology; however, there are some common clinical and radiological characteristics and in some cases a common treatment approach that unifies these conditions to a specific group, hence the NAADs. Clinicians and radiologists often fail to recognize NAADs, and there might be a delay in the management of such patients; this may result in seriously adverse outcomes that could otherwise have been avoided or minimized. Knowledge of these conditions and of their radiological appearances is therefore important to help establish a correct diagnosis to allow the prompt initiation of treatment. The purpose of this pictorial review is to present a selection of NAADs cases and to discuss the radiological characteristics and the most common lines of therapeutic approaches.
Collapse
|
33
|
Venous Adventitial Cystic Disease: A Review of 45 Cases Treated Since 1963. Int J Vasc Med 2016; 2016:5287697. [PMID: 27885342 PMCID: PMC5112310 DOI: 10.1155/2016/5287697] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/05/2016] [Indexed: 12/03/2022] Open
Abstract
Purpose. To review and identify the most accurate ways of diagnosing and treating adventitial cystic disease (ACD) of the venous system. Methods. Cases of ACD were collected through three popular medical databases, including PubMed, Cochrane, OVID, and MEDLINE. After reviewing the literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and all cases of arterial ACD were excluded. The clinical features, treatment, and subsequent course of 45 cases of venous ACD are included in this paper. Results. After reviewing all 45 cases of venous ACD , we have confirmed that the most common vessel affected is the common femoral vein, which reproduces the most common symptom of venous ACD: asymmetric lower extremity swelling worsening over time. Conclusion. Venous ACD most commonly affects the common femoral vein. When unilateral leg swelling occurs with or without a noticeable mass, ACD should be considered. It is best confirmed with CT venography and the treatment of choice is transluminal cyst evacuation and excision.
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Khoury M. Failed Angioplasty of a Popliteal Artery Stenosis Secondary to Cystic Adventitial Disease. Vasc Endovascular Surg 2016; 38:277-80. [PMID: 15181512 DOI: 10.1177/153857440403800314] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this case review is to describe treatment options for arterial occlusive disease secondary to a popliteal cyst. The occurrence of this disease is significantly less than atherosclerosis as the cause of claudication. The clinical presentation, natural history, and treatment options are reviewed.
Collapse
Affiliation(s)
- Michael Khoury
- Department of Surgery, St. Joseph Mercy of Macomb, Macomb and St. Clair Vascular Associates, St. Clair Shores, MI, USA.
| |
Collapse
|
36
|
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.
Collapse
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.
| |
Collapse
|
37
|
Kim YK, Chun HJ, Hwang JK, Kim JI, Kim SD, Park SC, Moon IS. Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis. Asian J Surg 2016; 39:178-81. [DOI: 10.1016/j.asjsur.2013.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/15/2012] [Accepted: 07/09/2013] [Indexed: 11/29/2022] Open
|
38
|
Jindal R, Majed A, Hamady M, Wolfe JH. Cystic Adventitial Disease of the Iliofemoral Artery: Case Reports and a Short Review. Vascular 2016; 14:169-72. [PMID: 16956491 DOI: 10.2310/6670.2006.00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cystic adventitial disease is a rare disease affecting mainly young males. We describe two patients with this disease affecting the iliofemoral artery. These reports reemphasize the importance of keeping cystic adventitial disease as a differential diagnosis in young patients who present with leg ischemia.
Collapse
Affiliation(s)
- Ravul Jindal
- Department of Vascular Surgery, St. Mary's Hospital, London, UK.
| | | | | | | |
Collapse
|
39
|
Abid A, Kelley JF, Flemming DJ, Silvis ML. A young male runner with a posterior knee mass--not just your typical Baker's cyst. BMJ Case Rep 2016; 2016:bcr-2015-213750. [PMID: 26933185 DOI: 10.1136/bcr-2015-213750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 28-year-old man with a growing mass in his right popliteal fossa causing pain on exertion. The differential diagnosis included Baker's cyst, entrapment syndrome of the popliteal artery, as well as a benign or malignant neoplasm. An ultrasound was non-specific. Follow-up MRI of the knee demonstrated cystic adventitial disease (CAD). With only about 500 cases reported in the literature since its discovery in 1947, CAD is a rare entity. The disease is characterised by mucinous or gelatinous cysts in the arterial or venous adventitia. The disease is predominantly seen in the popliteal artery and typically affects otherwise healthy males in the fourth to fifth decade of life. It presents clinically as intermittent exertional claudication. Examination of our case and a review of the literature will highlight the importance of considering CAD in patients who report of a popliteal mass and intermittent claudication.
Collapse
Affiliation(s)
- Ayesha Abid
- Department of Family and Community Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA Department of Radiology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - James Fitzhugh Kelley
- Department of Family and Community Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Donald J Flemming
- Department of Radiology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Matthew L Silvis
- Department of Family and Community Medicine, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA Department of Orthopedics and Rehabilitation, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
40
|
Takasawa Y, Mizuno S, Maekawa N, Yamaguchi J, Suzuki M, Tsuchida M, Saga M, Kokado H, Misawa K, Murakami T, Moriuchi I, Ohsato K. Diagnosis of adventitial cystic disease of the popliteal artery by optical coherence tomography. Int J Cardiol 2016; 203:653-5. [PMID: 26580350 DOI: 10.1016/j.ijcard.2015.10.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Yosuke Takasawa
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center.
| | - Sumio Mizuno
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | - Naoto Maekawa
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | - Junya Yamaguchi
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | - Masatomo Suzuki
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | | | - Makoto Saga
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | - Hiromasa Kokado
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | - Katsushi Misawa
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | | | - Ikuo Moriuchi
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| | - Kazuo Ohsato
- Division of Cardiovascular Medicine, Fukui Cardiovascular Center
| |
Collapse
|
41
|
Abstract
Cystic adventitial disease of the popliteal artery is a relatively rare entity, responsible for approximately 1 in 1,200 cases of claudication. We present a case with both classic history and imaging features. We hope that our experiences may increase radiologists’ familiarity with this unusual but treatable entity.
Collapse
|
42
|
Fatic N, Nikolic A, Maras D, Bulatovic N. Cystic Adventitial Disease in Former Athlete. Open Access Maced J Med Sci 2015; 3:429-31. [PMID: 27275264 PMCID: PMC4877833 DOI: 10.3889/oamjms.2015.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 11/05/2022] Open
Abstract
In this paper we present a 39-year old former athlete complaining with pain in his legs during long walk resembling to intermittent claudication. Color duplex scan described a popliteal artery with 10 mm in diameter with mural thrombus that caused stenosis 75% of lumen. Digital subtraction angiography demonstrated a stenosis of right popliteal artery. The suspicion for Cystic adventitial disease was set. The patient was operated on by posterior direct approach. After incision, a yellowish viscous material was observed in adventitia. Partial resection of the affected popliteal artery and replacement by an autogenous great saphenous vein graft was performed. Patient was dismissed on the seventh postoperative day, in good condition and without any complication. Cystic adventitial disease of the popliteal artery should be considered in the differential diagnosis of intermittent claudication, especially in former sportsmen patients. Partial resection of the affected popliteal artery and replacement by an autogenous great saphenous vain graft produces excellent results.
Collapse
Affiliation(s)
- Nikola Fatic
- Clinical Centre of Montenegro, University of Montenegro, Podgorica, Montenegro
| | - Aleksandar Nikolic
- Clinical Centre of Montenegro, University of Montenegro, Podgorica, Montenegro
| | - Dejan Maras
- Clinical Centre of Montenegro, University of Montenegro, Podgorica, Montenegro
| | - Nikola Bulatovic
- Clinical Centre of Montenegro, University of Montenegro, Podgorica, Montenegro
| |
Collapse
|
43
|
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.
Collapse
|
44
|
McGinley JC. Nonsurgical treatment of cystic adventitial disease of the popliteal artery caused by functional popliteal artery entrapment syndrome. J Vasc Surg Cases 2015; 1:28-31. [PMID: 31724585 PMCID: PMC6849991 DOI: 10.1016/j.jvsc.2015.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/26/2015] [Indexed: 10/31/2022] Open
Abstract
Lower extremity claudication in young men can be caused by popliteal artery entrapment and vascular pathology. The case reported here describes a young male wrestler who presented with unilateral calf pain with activity. Imaging studies at rest demonstrated cystic adventitial disease of the popliteal artery. Stress imaging showed severe functional popliteal artery entrapment. This patient was treated with an imaging-guided botulinum toxin injection of the muscles at the site of arterial compression. The patient was asymptomatic 6 weeks after treatment. Repeat stress imaging demonstrated complete resolution of the entrapment and nearly complete resolution of the popliteal artery cystic adventitial disease.
Collapse
Affiliation(s)
- Joseph C McGinley
- Casper Medical Imaging, Casper, Wyo.,Stanford University, Stanford, Calif.,University of Washington, Seattle, Wash
| |
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Park SJ, Park WS, Min SY, Kwon SH, Park MS, Ahn HJ. Cystic adventitial disease of the common femoral artery at a previous surgical dissection site. Ann Vasc Surg 2014; 29:365.e1-3. [PMID: 25463335 DOI: 10.1016/j.avsg.2014.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/12/2014] [Accepted: 08/31/2014] [Indexed: 10/24/2022]
Abstract
Cystic adventitial disease (CAD) is a rare vascular disorder associated with nonatherosclerotic peripheral vessel disease and occurs when mucoid cysts in the adventitia compress the blood vessel. The underlying etiology and pathogenesis of CAD remain debatable as various theories have been suggested. This case is interesting because the cyst developed from the previous common femoral artery (CFA) dissection site. To our knowledge, this is the first report of CAD developed at a previous operation site. Thus, we report herein a case of CAD arising from a previous embolectomy dissection site in the CFA that was successfully treated with surgery.
Collapse
Affiliation(s)
- Sun Jin Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Won Seo Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Sun Young Min
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Se Hwan Kwon
- Department of Radiology, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Min Soo Park
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Hyung Joon Ahn
- Department of Surgery, Kyung Hee University School of Medicine, Seoul, South Korea.
| |
Collapse
|
47
|
Sharma AM, Norton PT, Zhu D. Conditions presenting with symptoms of peripheral arterial disease. Semin Intervent Radiol 2014; 31:281-91. [PMID: 25435652 DOI: 10.1055/s-0034-1393963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Peripheral artery disease (PAD) is estimated to affect more than 20% of people older than 65 years. The vast majority of patients with symptoms suggestive of PAD have atherosclerosis often associated with conventional vascular risk factors such as smoking, diabetes, dyslipidemia, and inflammation. A minority of people presenting with symptoms suggesting PAD have an alternative etiology. These groups of disorders are often underdiagnosed, and if diagnosed correctly the diagnosis may be delayed. Understanding these pathologies well is important, as they can be very debilitating and optimal treatment may vary significantly. Inappropriate treatment of these disorders can lead to worsening morbidity and mortality. This article discusses the underlying causes of nonatherosclerotic PAD, including the diagnosis and treatment of these disorders.
Collapse
Affiliation(s)
- Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia
| | - Patrick T Norton
- Department of Radiology, University of Virginia, Charlottesville, Virginia
| | - Daisy Zhu
- Medical Education, University Virginia School of Medicine, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
48
|
Apigian AK, Landry GJ. Basic data underlying decision making in nonatherosclerotic causes of intermittent claudication. Ann Vasc Surg 2014; 29:138-53. [PMID: 25277047 DOI: 10.1016/j.avsg.2014.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 01/13/2023]
Abstract
Although most cases of vasculogenic intermittent claudication are caused by atherosclerosis, there is an important minority of cases that are due to nonatherosclerotic causes. Because of their rarity and younger population affected, often without traditional atherosclerotic risk factors, there is frequently a significant delay in diagnosis of nonatherosclerotic peripheral arterial diseases by several months to years in some cases. Here, we review the literature on nonatherosclerotic causes of lower extremity claudication, symptoms, management including surgical and endovascular interventions, and outcomes. Conditions included are popliteal artery entrapment syndrome, cystic adventitial disease, pseudoxanthoma elasticum, persistent sciatic artery, fibromuscular disease, giant cell arteritis, iliac endofibrosis, neurogenic claudication, and chronic exertional compartment syndrome.
Collapse
Affiliation(s)
- Aimie K Apigian
- Knight Cardiovascular Institute, Oregon Health & Science University, Sam Jackson Park Road, Portland, OR
| | - Gregory J Landry
- Knight Cardiovascular Institute, Oregon Health & Science University, Sam Jackson Park Road, Portland, OR.
| |
Collapse
|
49
|
Zhang H, Zhang Y, Wang Q, Zhao WG, Wang JJ. Cystic adventitial disease of the popliteal artery: report of two cases. Surg Today 2014; 44:1760-3. [PMID: 23904046 PMCID: PMC4138484 DOI: 10.1007/s00595-013-0675-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 04/01/2013] [Indexed: 11/29/2022]
Abstract
Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disorder in which a mucin-containing cyst develops in the adventitial layer of the artery. We report two such cases, each of which was treated differently. The first case was of a 49-year-old man, treated by excision of the involved arterial segment and interposition of an autologous saphenous vein graft. The second case was of a 36-year-old man, treated by local excision of the affected arterial segment and interposition with prosthetic bypass grafting. Both patients presented with rapidly progressing intermittent claudication of the lower extremities, but without remarkable evidence of atherosclerotic disease. Physical examination revealed diminished or absent popliteal, posterior tibial and dorsalis pedis pulses in the lower extremities. Color Doppler ultrasound of the popliteal artery revealed hypoechoic cystic lesions surrounding the vessel, and popliteal arterial stenosis, in both patients. Surgery resulted in immediate improvement of the arterial pulse distal to the lesion. Both patients recovered uneventfully. Thus, resection of the involved artery segment and interposition bypass grafting, using either patient or prosthetic veins, offers favorable results for CAD of the popliteal artery.
Collapse
Affiliation(s)
- Hua Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Jilin University, 908 Mingde Road, Chaoyang District, Changchun, 130021 Jilin Province China
| | - Yang Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Jilin University, 908 Mingde Road, Chaoyang District, Changchun, 130021 Jilin Province China
| | - Qi Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Jilin University, 908 Mingde Road, Chaoyang District, Changchun, 130021 Jilin Province China
| | - Wen-Guang Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Jilin University, 908 Mingde Road, Chaoyang District, Changchun, 130021 Jilin Province China
| | - Jia-Ju Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Jilin University, 908 Mingde Road, Chaoyang District, Changchun, 130021 Jilin Province China
| |
Collapse
|
50
|
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.
Collapse
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
| | | | | | | |
Collapse
|