A case of claudication in a young man

Abstract

A 37-year-old man presented with a 2-month history of right-sided calf pain when he walked. This had started suddenly. The pain was forcing him to stop after 5 minutes of walking and subsided following a prolonged period of rest. He smoked 5 cigarettes a day, but had no other risk factors for peripheral vascular disease. On examination of his peripheral vascular system the right posterior tibial and dorsalis pedis pulses were absent and the popliteal pulse was markedly diminished compared to the left. Femoral pulses were present and there were no other stigmata of peripheral vascular disease. A femoral angiogram was performed which demonstrated a normal aorta, iliac and femoral vessels. There was a short occlusion of the distal right popliteal artery for a segment of 3 cm with a smooth rounded filling defect arising from the anteromedial wall of the popliteal artery just above the occlusion (Figure 1). Exploration of the popliteal artery revealed a cyst arising from the above knee popliteal artery which was incised, expressing clear fluid similar to that found in joint ganglia. A short jump graft using the long saphenous vein was fashioned around the occluded segment with good symptom relief. Histological examination of the cyst wall showed fibrocollagenous connective tissue devoid of an epithelial lining. A diagnosis of cystic adventitial disease was made.