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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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2
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Stammler F, Wenzler M. [Rare cause of calf pain in a 56-year-old female patient: cystic adventitial degeneration of the popliteal artery]. Dtsch Med Wochenschr 2023; 148:242-245. [PMID: 36848887 DOI: 10.1055/a-1976-4185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Cystic adventitial degeneration (CAD) is a rare vascular disease, affects mostly middle-aged men, and as a nonatherosclerotic disease, is an uncommon differential diagnosis of intermittent claudication. CASE HISTORY A 56-year-old female patient presented to our medical office because of unexplained right-sided calf pain that was not constantly load-dependent. The complaints fluctuated considerably with longer symptom-free intervals. EXAMINATION AND FINDINGS Clinically, the patient presented regular pulses, which were maintained even with provocative maneuvers such as plantar flexion and knee flexion. Duplex sonography showed cystic masses around the popliteal artery. On MRI examination, a tubular tortuous connection to the knee joint capsule also appeared to be visualizable. A diagnosis of cystic adventitial degeneration was made. THERAPY AND COURSE In the absence of constant impairment of walking performance with symptom-free intervals as well as morphological and functional signs of stenosis, interventional or surgical therapy was not desired by the patient. Short-term follow-up revealed stable clinical and sonomorphologic findings over an observation period of 6 months so far. DISCUSSION CAD should also be considered in female patients with atypical leg symptoms. There are no uniform treatment recommendations for CAD, which is why it is a challenge to select the optimal, usually interventional procedure. In patients with few symptoms and no critical ischemia, a conservative approach with close follow-up may be justified, as in our case report.
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Affiliation(s)
- Frank Stammler
- Praxis für Gefäßmedizin und Venenzentrum, Bad Wildbad, GERMANY
| | - Marion Wenzler
- Praxis für Gefäßmedizin und Venenzentrum, Bad Wildbad, GERMANY
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3
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Nieto LA, Cabrera Vargas LF, Lozada‐Martínez ID, Guardo‐Carmona D, Contreras M, Pedraza M, Narvaez‐Rojas AR. Cystic adventitial disease of popliteal artery, the both sides of the coin: Arterial resection vs cyst excision. Clin Case Rep 2022; 10:e05754. [PMID: 35441030 PMCID: PMC9010953 DOI: 10.1002/ccr3.5754] [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: 03/05/2022] [Revised: 03/20/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Adventitial cystic disease (ACD) is a rare form of non‐atherosclerotic arterial stenosis. This entity accounts only for 0.1% of all vascular diseases and affects the popliteal artery unilaterally in 85% of the cases. The options for treatment ACD include excision of cysts, removal of the affected arterial segment with vein graft reconstruction or radiological aspiration. We present two cases of ACD of the popliteal artery and its subsequent management and discuss the pros and cons of the treatment's strategies. In patients with cystic adventitial disease of popliteal artery, surgical conservative treatment with cyst excision can be performed if no complete arterial wall alteration and no presence of arterial thrombosis, compared with arterial resection.![]()
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Affiliation(s)
- Luis Alejandro Nieto
- Department of Vascular and Endovascular Surgery Hospital Militar Central Universidad Militar Nueva Granada Bogotá Colombia
| | - Luis Felipe Cabrera Vargas
- Department of Vascular and Endovascular Surgery Hospital Militar Central Universidad Militar Nueva Granada Bogotá Colombia
- Medical and Surgical Research Center Future Surgeons Chapter Colombian Surgery Association Bogotá Colombia
| | - Ivan David Lozada‐Martínez
- Medical and Surgical Research Center Future Surgeons Chapter Colombian Surgery Association Bogotá Colombia
- Research Unit Bolivar Chapter Asociación Colombiana Médica Estudiantil (ACOME) Cartagena Colombia
- Standing Committee on Scientific Evaluation and Development (CPEDEC) Asociación Científica de Estudiantes de Medicina de la Universidad de Santander (ACEMUDES) Bucaramanga Colombia
| | - Daniela Guardo‐Carmona
- Medical and Surgical Research Center Future Surgeons Chapter Colombian Surgery Association Bogotá Colombia
- Research Unit Bolivar Chapter Asociación Colombiana Médica Estudiantil (ACOME) Cartagena Colombia
| | - Martin Contreras
- Department of Surgery Hospital San Rafael Universidad Militar Nueva Granada Bogotá Colombia
| | | | - Alexis Rafael Narvaez‐Rojas
- Department of Surgery Hospital Carlos Roberto Huembes Universidad Nacional Autonoma de Nicaragua Managua Nicaragua
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Mikhaylov IP, Lavrenov VN, Titova GP, Lepekhina IS. [Adventitial cyst of the popliteal artery]. Khirurgiia (Mosk) 2021:83-89. [PMID: 33395517 DOI: 10.17116/hirurgia202101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vascular cystic adventitious degeneration (CAD) is a rare disease of unclear etiology that affects mainly the popliteal artery (up to 85-90% of cases). Clinical manifestations are similar to aneurysm of the popliteal artery. CAD occurs mainly in males of the 4th and 5th decades of life (range 10-77 years). These patients usually have no risk factors of cardiovascular diseases. Unilateral symptoms prevail. We report a review and a 46-year-old patient with CAD of the popliteal artery.
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Affiliation(s)
- I P Mikhaylov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - V N Lavrenov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - G P Titova
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - I S Lepekhina
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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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
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6
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Jeong S, Kwon TW, Han Y, Cho YP. Effectiveness of Surgical Treatment with Complete Cyst Excision for Cystic Adventitial Disease of the Popliteal Artery. Ann Vasc Surg 2020; 72:261-269. [PMID: 32946995 DOI: 10.1016/j.avsg.2020.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/23/2020] [Accepted: 09/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cystic adventitial disease is a rare, nonatherosclerotic disease that affects various arteries and veins, involving the formation of a mucinous cyst within the adventitia. The etiology of the cystic adventitial disease is currently unclear, with several hypotheses having been suggested. The purpose of this retrospective observational study was to evaluate the etiology of popliteal cystic adventitial disease based on imaging and surgical findings and to evaluate the efficacy of surgical treatment. METHODS From April 2013 to January 2020, nine patients were diagnosed with the popliteal cystic adventitial disease and underwent surgical treatment. We performed complete resection of the cyst and the affected segment of the popliteal artery, followed by interposition with autologous reversed small saphenous vein or great saphenous vein. RESULTS The resected adventitial cyst tissue was multilobular, filled with high-viscosity mucus. Pathologic examination of the surgical specimen revealed intramural cysts filled with gelatinous material located between the media and the adventitia, consistent with the clinical diagnosis of cystic adventitial disease. The median follow-up period was 27.5 months (range: 2-91 months). All patients underwent cyst excision with graft interposition, and the overall graft patency was 80.9 months (95% CI: 62.2-99.6 months). CONCLUSIONS Computed tomography, magnetic resonance imaging, and surgical findings confirmed communication between the synovial cyst and arterial adventitia. It is recommended that priority be given to surgical resection and graft interposition because this can eliminate the disease's cause and reduce its recurrence.
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Affiliation(s)
- Seonjeong Jeong
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Youngjin Han
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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7
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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 DJ, Park HO, Jang HN, Kim KN, Yang JH, Moon SH, Byun JH, Kim SH, Choi JY, Jang IS, Kim JW, Lee CE. A Report of Two Cases of Adventitial Cystic Disease of the Popliteal Artery. Knee Surg Relat Res 2018; 30:167-170. [PMID: 29715714 PMCID: PMC5990233 DOI: 10.5792/ksrr.17.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/06/2017] [Accepted: 10/07/2017] [Indexed: 12/02/2022] Open
Abstract
Two patients were admitted to our department because of recent aggravation of claudication in the leg, which was exacerbated by walking. They were diagnosed as having a Baker cyst or acute thrombosis in the popliteal fossa at another hospital. There was no evidence of ischemia, and the ankle brachial index was normal. Computed tomography and magnetic resonance imaging were performed, revealing a cystic mass of the popliteal artery (PA). Intraoperatively, the cystic lesion was found within the adventitia of the PA; based on the biopsy findings, both patients were diagnosed as having adventitial cystic disease of the PA.
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Affiliation(s)
- Doo Jae Lee
- Division of Foot and Ankle, Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun Oh Park
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Ha Nee Jang
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ki Nyun Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jun Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Seong Ho Moon
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Joung Hun Byun
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Sung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jun Young Choi
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - In Seok Jang
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jong Woo Kim
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Chung Eun Lee
- Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
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9
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Cystic Adventitial Disease of Popliteal Artery with Venous Aneurysm of Popliteal Vein: Two-Year Follow-Up after Surgery. Case Rep Vasc Med 2017; 2017:4873474. [PMID: 29230344 PMCID: PMC5688377 DOI: 10.1155/2017/4873474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 10/16/2017] [Indexed: 11/17/2022] Open
Abstract
We report a rare case of cystic adventitial disease of popliteal artery with venous aneurysm of popliteal vein. A 46-year-old woman had sudden-onset intermittent claudication and coldness in her right leg. The right-sided ankle-brachial pressure index (ABI) was 1.01, but peripheral arterial pulsation was decreased at knee venting position. Computed tomography revealed simple cystic lesion of the popliteal artery and stenosis of the arterial lumen in this lesion. The patient was treated by complete resection of the cystic adventitial layer of popliteal artery. A venous aneurysm of popliteal vein was revealed by intraoperative echo and was simply ligated. The patient had uneventful postoperative course and no symptoms of relevance during the two years of follow-up.
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10
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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.
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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
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11
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Abstract
Atherosclerotic peripheral artery disease is the most common cause of intermittent claudication. Nonatherosclerotic peripheral artery disease is a heterogeneous collection of diseases affecting the extracoronary arteries which is not due to atherosclerosis. These diseases include, but are not limited to, popliteal artery entrapment syndrome, cystic adventitial disease, external iliac endofibrosis, and thromboangiitis obliterans. Due to its relatively low prevalence, nonatherosclerotic peripheral artery disease may be misdiagnosed leading to the mismanagement of potentially treatable conditions. The proper and timely diagnosis of these conditions is paramount to the prevention of adverse outcomes as treatments widely vary. The diagnostic approach to patients presenting with intermittent claudication must take into account both atherosclerotic as well as nonatherosclerotic causes of peripheral artery disease making the differential vital to clinical practice.
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Affiliation(s)
- Ari J Mintz
- Internal Medicine, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA, 01805, USA,
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12
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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.
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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
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13
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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.
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15
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Abstract
OBJECTIVE Patients who undergo knee MRI for presumed musculoskeletal disease can have unexpected vascular findings or pathology in the imaged field. Some vascular processes are limb threatening and affect treatment planning and patient outcome. CONCLUSION Unexpected vascular findings on knee MRI can range from incidental to symptomatic and can include such processes as variant anatomy, aneurysm, traumatic injury, and neoplasm. The assessment for vascular pathology should be a key component of every radiologist's search pattern when evaluating knee MRI.
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16
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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.
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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
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17
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Clinical Results of Cystic Excision for Popliteal Artery Cystic Adventitial Disease: Long-term Benefits of Preserving the Intact Intima. Ann Vasc Surg 2014; 28:1567.e5-8. [DOI: 10.1016/j.avsg.2014.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/31/2013] [Accepted: 01/28/2014] [Indexed: 11/18/2022]
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18
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Del Canto Peruyera P, Vázquez MJVV, Velasco MB, Álvarez PC, Salgado AÁ, Álvarez JC, Fernández LJÁ. Cystic adventitial disease of the popliteal artery: Two case reports and a review of the literature. Vascular 2014; 23:204-10. [PMID: 24986869 DOI: 10.1177/1708538114541652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two cases of cystic adventitial disease treated at our institution over the last year are presented. They were middle-aged and apparently healthy patients, and the symptoms begin with a sudden onset of unilateral claudication. After performing a magnetic resonance angiography, a cystic formation attached to the adventitia of the popliteal artery was identified. Both patients were treated in the same manner, with resection of the affected arterial segment and vein bypass interposition. Both remain asymptomatic after one year of follow-up in one case and six months in the other. Cystic adventitial disease is a rare entity, which presents in patients without cardiovascular risk factors, so sometimes it takes long to reach a definitive diagnosis. Concerning the different treatment options, cyst excision together with the affected arterial segment seems to offer better mid- and long-term results when compared with other treatment options such as cyst aspiration or endovascular techniques, although there are no multicenter trials evidencing the superiority of one against the others.
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Affiliation(s)
- P Del Canto Peruyera
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | | | - M Botas Velasco
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - P Calvín Álvarez
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - A Álvarez Salgado
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - J Cerviño Álvarez
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - L J Álvarez Fernández
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
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19
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Desy NM, Spinner RJ. The etiology and management of cystic adventitial disease. J Vasc Surg 2014; 60:235-45, 245.e1-11. [DOI: 10.1016/j.jvs.2014.04.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/06/2014] [Indexed: 12/20/2022]
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20
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Hernández Mateo MM, Serrano Hernando FJ, Martínez López I, González Sánchez S, Hernando Rydings M, Saiz Jerez A, Revuelta Suero S, Marqués de Marino P. Cystic Adventitial Degeneration of the Popliteal Artery: Report on 3 Cases and Review of the Literature. Ann Vasc Surg 2014; 28:1062-9. [DOI: 10.1016/j.avsg.2013.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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21
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Welman CJ, Harrison C, Low RS. Contrast-enhanced magnetic resonance angiography of the peripheral arteries: technique, tips, pitfalls and problems. J Med Imaging Radiat Oncol 2013; 57:125-40. [PMID: 23551769 DOI: 10.1111/1754-9485.12027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 10/02/2012] [Indexed: 11/30/2022]
Abstract
Contrast-enhanced magnetic resonance angiography is a reliable way to assess peripheral vascular disease. This article reviews the basic physics behind this technique and discusses our institution's experience with regard to the clinical role, recent advances in image acquisition and use of contrast agents. Problems that can affect image quality and interpretation are also highlighted.
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Affiliation(s)
- Christopher J Welman
- Department of Radiology, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia
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22
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Gupta R, Mittal P, Gupta P, Jindal N. Cystic adventitial disease of popliteal artery with significant stenosis. Indian J Radiol Imaging 2013; 23:148-50. [PMID: 24082480 PMCID: PMC3777325 DOI: 10.4103/0971-3026.116572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein.
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Affiliation(s)
- Ranjana Gupta
- Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Puneet Mittal
- Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Praveen Gupta
- Department of Medicine, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Nancy Jindal
- Department of Radiodiagnosis, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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23
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Spinner RJ, Desy NM, Agarwal G, Pawlina W, Kalra M, Amrami KK. Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint-connected. Clin Anat 2012; 26:267-81. [DOI: 10.1002/ca.22152] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/26/2012] [Indexed: 11/09/2022]
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24
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Kawarai SI, Fukasawa M, Kawahara Y. Adventitial cystic disease of the popliteal artery. Ann Vasc Dis 2012; 5:190-3. [PMID: 23555509 DOI: 10.3400/avd.cr.11.00069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 01/21/2012] [Indexed: 11/13/2022] Open
Abstract
We describe a patient with adventitial cystic disease of the popliteal artery with intermittent claudication involving the right calf during exercise. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a cystic lesion that encircled and compressed the popliteal artery. Resection of the cyst involving a segment of the affected popliteal artery and interposing an autologous vein graft resolved the symptoms, and the postoperative course was uneventful. The cyst was histologically similar to a ganglion.
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Affiliation(s)
- Shun-Ichi Kawarai
- Department of Cardiovascular Surgery, Hachinohe City Hospital, Hachinohe, Aomori, Japan
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25
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Paravastu SCV, Regi JM, Turner DR, Gaines PA. A Contemporary Review of Cystic Adventitial Disease. Vasc Endovascular Surg 2011; 46:5-14. [DOI: 10.1177/1538574411419377] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cystic adventitial disease (CAD) is a rare vascular disorder, predominantly seen in young healthy men with minimal cardiovascular risk factors. Cystic adventitial disease can affect both arteries and veins. Patients with arterial CAD present with sudden onset or rapidly progressing claudication symptoms, and those with venous CAD present with limb swelling or very rarely deep vein thrombosis. Diagnosis is confirmed with the aid of imaging techniques such as ultrasonography, computed tomography, or magnetic resonance scan. Surgical resection or evacuation of the lesion is usually the preferred approach, with only mixed results reported for percutaneous endovascular techniques.
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Affiliation(s)
- Sharath C. V. Paravastu
- Academic Vascular Unit, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - John M. Regi
- Department of Vascular Interventional Radiology, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Douglas R. Turner
- Department of Vascular Interventional Radiology, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Peter A. Gaines
- Department of Vascular Interventional Radiology, Northern General Hospital, Sheffield, South Yorkshire, UK
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26
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Drac P, Köcher M, Utikal P, Cerna M, Kozak J, Bachleda P. CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY: REPORT ON THREE CASES AND REVIEW OF THE LITERATURE. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 155:309-21. [DOI: 10.5507/bp.2011.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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