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Sassi F, Azouz H, Hermes S, Zehani A, Haouet S. Cystic adventitial disease of the popliteal artery: A case report with review of literature. Int J Surg Case Rep 2024; 117:109541. [PMID: 38522307 PMCID: PMC10973812 DOI: 10.1016/j.ijscr.2024.109541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cystic adventitial disease (CAD) is a rare vascular disorder marked by occlusion stemming from the development of a cystic mass within the outer (subadventitial) layer, with a predominant impact on the popliteal artery. The significance of the case presented herein lies in shedding light on a distinct clinical manifestation involving a 40-year-old man who exhibited sporadic calf claudication during ambulation. This instance contributes to the broader understanding of CAD and its diverse clinical presentations, emphasizing the need for further exploration and awareness within the medical community. CASE PRESENTATION A 40-year-old man, with no significant past medical history, was referred to the cardiovascular department for the evaluation of a new onset of left calf pain persisting over the past three months. An arterial lower limb Doppler ultrasound was performed, revealing a focal hypoechoic image around the popliteal artery with a regular arterial wall, indicative of extrinsic compression. This resulted in significant stenosis of the popliteal artery during plantar flexion of the foot. The diagnosis of CAD of the left popliteal artery was established after limb computed tomography angiography, and a complete resection of the cyst was scheduled. The postoperative course was uneventful, with the patient experiencing relief from left calf claudication. CLINICAL DISCUSSION CAD is an uncommon vascular anomaly, representing merely 0.1 % of all vascular conditions. This condition predominantly afflicts men aged between 40 and 50 years old. The etiology of CAD remains a subject of debate, with pathological findings typically involving intramural cysts containing gelatinous material between the media and the adventitia. Surgical intervention becomes necessary when symptoms arise. CONCLUSION CAD of the popliteal artery, though rare, is a significant contributor to peripheral vascular insufficiency in young patients without typical atherosclerotic risk factors.
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Affiliation(s)
- Farah Sassi
- Pathology Department, Rabta hospital, Tunis, Tunisia.
| | - Heifa Azouz
- Pathology Department, Rabta hospital, Tunis, Tunisia
| | | | - Alia Zehani
- Pathology Department, Rabta hospital, Tunis, Tunisia
| | - Slim Haouet
- Pathology Department, Rabta hospital, Tunis, Tunisia
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Calderwood AC, Palan R, Ponosh S. Cystic adventitial disease masquerading as ganglion disease: a rare cause of intermittent claudication. BMJ Case Rep 2022; 15:e251707. [PMID: 36585048 PMCID: PMC9809221 DOI: 10.1136/bcr-2022-251707] [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] [Indexed: 12/31/2022] Open
Abstract
Cystic adventitial disease (CAD) is a rare cause of claudication in which a mucinous cyst forms within the adventitial layer of a blood vessel, most commonly the popliteal artery, resulting in luminal narrowing. This paper presents a case of a man in his mid-50s with unilateral lower limb popliteal artery CAD, which was not initially identified on either duplex ultrasonography or CT angiography. He was successfully treated with surgical resection of the affected segment of the popliteal artery and autologous vein grafting.
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Affiliation(s)
| | - Ranesh Palan
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Stefan Ponosh
- Hollywood Private Hospital, Nedlands, Western Australia, Australia
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Lee JS, Kim SD. Surgical management for adventitial cystic disease of common femoral vein. Asian J Surg 2021; 44:1572-1573. [PMID: 34503872 DOI: 10.1016/j.asjsur.2021.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Jong Seok Lee
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Sang Dong Kim
- Division of Vascular and Transplant Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea.
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Higami S, Ueda T, Sakakibara Y, Tohyama A, Harada H, Kurita T, Kagami S, Matsuura Y, Yoshino K. Laparoscopically Resected Venous Adventitial Cystic Disease that was Difficult to Distinguish from an Ovarian Tumor. J UOEH 2020; 42:51-55. [PMID: 32213742 DOI: 10.7888/juoeh.42.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Adventitial cystic disease (ACD) is a rare condition in which a mucinous cyst forms within the adventitia, usually in arteries but rarely in veins. A 79-year-old patient presented with stomachache and nausea. Computerized tomography showed pelvic cysts on either side of the pelvis. The right tumor was 120×100 mm, and the left tumor was 45×35 mm. Our diagnosis was bilateral ovarian tumors and we performed laparoscopic tumor resection. In the abdominal cavity, we saw that the left ovary was swollen by about 3-4 cm and the right ovary was normal size. There was a mucous cyst located in the right retroperitoneal cavity that adhered around and bordered the right external iliac vein and the right obturator nerve. We peeled the adhesion away carefully and resected the tumor but the operation caused temporary obturator nerve paralysis. From pathological examination, we diagnosed the right retroperitoneal cyst to be venous ACD originating from the right external iliac vein. We found that venous ACD can grow as large as a pelvic tumor and is difficult to distinguish from an ovarian tumor, which is why we chose laparoscopic surgery. In this case, we performed the operation laparoscopically and no sequelae or recurrent tumor appeared during a 1-year follow-up. However, graft replacement is sometimes necessary for ACD, thus venous ACD should be considered a differential diagnosis and a surgical strategy should be developed when pelvic tumors are observed.
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Affiliation(s)
- Shota Higami
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Taeko Ueda
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yu Sakakibara
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Atsushi Tohyama
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Hiroshi Harada
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Tomoko Kurita
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Seiji Kagami
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Yusuke Matsuura
- Department of Nursing of Human Broad Development, School of Health Sciences, University of Occupational and Environmental Health, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan
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Rog CJ, French B, Kobayashi E, Tan SL. Cystic Adventitial Disease of the Common Femoral Vein Successfully Treated with Resection, Synthetic Graft Reconstruction, and Fistula Creation. Ann Vasc Surg 2019; 64:408.e1-408.e3. [PMID: 31634606 DOI: 10.1016/j.avsg.2019.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/27/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
Abstract
Cystic adventitial disease (CAD) is a rare, benign disease of blood vessels which most commonly affects the popliteal artery. Less than 50 cases of CAD affecting veins have ever been described in the literature to date. We report the case of a 56-year-old woman who presented with unilateral lower extremity swelling and varicosities due to CAD of her common femoral vein. Resection and reconstruction with a venous interposition graft, employing a polytetrafluoroethylene graft and arteriovenous fistula in order to maintain venous bypass patency, were performed successfully. The patient recovered well without any evidence of recurrence or postoperative complications.
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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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Lee JS, Hwang JK, Park SC, Kim SD. Surgical Management of Symptomatic Adventitial Cystic Disease of the Popliteal Artery as a Cause of Deep Vein Thrombosis. Chin Med J (Engl) 2018; 131:2141-2142. [PMID: 30127235 PMCID: PMC6111686 DOI: 10.4103/0366-6999.239320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jong Seok Lee
- Department of Surgery, Division Medical Detachment, Ministry of National Defense, Gangwon-do 24151, Korea
| | - Jeong Kye Hwang
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Sun Cheol Park
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Sang Dong Kim
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
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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.
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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
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Yu J, Lu C, Pan X, Li W. Cystic adventitial disease of the common femoral vein: A case report. Intractable Rare Dis Res 2016; 5:231-4. [PMID: 27672549 PMCID: PMC4995421 DOI: 10.5582/irdr.2016.01038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adventitial cystic disease (ACD) of the common femoral vein is a rare vascular disorder. It becomes more difficult to recognize preoperatively especially when the femoral vein is affected. We report the case of a 62-year-old female patient who presented with a one-month history of painless swelling in her right lower extremity. She had no specific past medical history and no history of trauma, and had a full coagulopathy profile that was negative for any hypercoagulable syndrome. On examination, her lower right leg was significantly swollen with a palpable mass in her right inguinal region. A computerized tomography (CT) with contrast was performed to provide more information and revealed an eccentric compression over the medial wall of the right common femoral vein. During surgical exploration, adventitial cystic mucinous disease was enucleated and the patient underwent femoral exploration, excision of the cysts and reconstruction of iliac femoral vein graft using an artificial blood vessel. The pathological examination confirmed the diagnosis. The patient continued to do well, and she had an unremarkable venous duplex evaluation at her 6-month follow-up. The presentation, investigation, treatment, and pathology of this condition are discussed with a literature review.
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Affiliation(s)
- Jimei Yu
- Department of Operation, Huashan North Hospital, Fudan University, Shanghai China
| | - Chaojun Lu
- Department of Operation, Huashan North Hospital, Fudan University, Shanghai China
| | - Xiaohua Pan
- Department of Operation, Huashan North Hospital, Fudan University, Shanghai China
| | - Weihua Li
- Department of Operation, Huashan North Hospital, Fudan University, Shanghai China
- Address correspondence to: Dr. Weihua Li, Department of Operation, Huashan North Hospital, Fudan university, No. 108, Luxiang Road, Baoshan District, Shanghai 201907, China. E-mail:
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