Cystic adventitial disease-case series and review of literature

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

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

Venous cystic adventitial disease: to cure or manage? A case series

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.

[Adventitial cyst of the popliteal artery]

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 4^th and 5^th 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.

Effectiveness of Surgical Treatment with Complete Cyst Excision for Cystic Adventitial Disease of the Popliteal Artery

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.

Cystic adventitial disease of the popliteal artery presenting with features of entrapment syndrome

Cystic adventitial disease is an uncommon cause of lower extremity claudication resulting from accumulation of mucinous fluid in an arterial subadventitial layer, typically of the popliteal artery. A popliteal bruit and/or reduced distal pulses with knee flexion may be seen on examination. Alternatively, popliteal artery entrapment syndrome triggers claudication via an aberrant arterial pathway or muscular hypertrophy. Decreased distal pressures with plantar or dorsiflexion is a key finding. This report details the case of a middle-aged male with cystic adventitial disease whose diagnosis was complicated by concurrent features of popliteal artery entrapment syndrome. Treatment consisted of venous interposition grafting, which yielded excellent results.

A case of cystic adventitial disease of the poplitealartery: selection of incision of the cyst wall overvessel replacement

Cystic adventitial disease (CAD), a rare arterial disorder, can cause localized arterial stenosis or obstruction. A 55-year-old man presented with a 2-month history of left lower leg pain and paleness when bending the left knee. The patient was diagnosed with CAD of the left popliteal artery based on imaging examinations. Surgery was performed with the patient placed in the prone position using an S-shaped skin incision, and the left popliteal artery was exposed. A simple incision of the cyst wall was made. There was no sign of recurrence at 1 year postoperatively.

Cystic adventitial disease of femoral vein presenting as enlarging lower limb swelling and pain: Two case reports and review of the literature

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.

Adventitial cystic disease of the common femoral vein misdiagnosed as deep vein thrombosis

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.

Management and patients perspective regarding a common peroneal nerve schwannoma: a rare cause of lower leg pain in a young individual

The differential diagnosis of exercise-induced lower leg pain in young individuals is extensive and includes entities such as chronic exertional compartment syndrome, popliteal arterial entrapment syndrome, cystic adventitial disease, medial tibial stress syndrome and tibial stress fractures. Peripheral nerve-related lower leg pain syndromes are unusual. We present a 41-year-old woman who was diagnosed with an ancient schwannoma of the right common peroneal nerve (CPN) as a rare cause of lower leg pain. This case report provides simple diagnostic bedside tools that may be used to diagnose CPN abnormalities. Altered lateral lower leg skin sensation was found using a simple cotton swab, whereas a nodule was palpated at the fibular head. A positive Tinel sign indicated CPN dysfunction. MRI confirmed the diagnosis. Surgical resection is simple and curative.