CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY: REPORT ON THREE CASES AND REVIEW OF THE LITERATURE

Petr Drac,Jiri Kozak,Petr Bachleda,Petr Utikal,Martin Köcher,Marie Cerna

doi:10.5507/bp.2011.065

Abstract

During the past nine years three cases of cystic adventitial disease of the popliteal artery have been diagnosed and treated in our medical institution. Different approaches were used in the treatment in all these cases. The purpose of this report is to summarise the current knowledge of the etiology, presentation, diagnostics and treatment of this condition, with the addition of new cases. Information about three new cases is presented and discussed together with that from the relevant publications obtained from the Pubmed database. Results. In the first case resection with synthetic graft interposition was used. Nine years after the surgery the patient is without any signs of recurrence, but he experienced local thrombolysis of the occluded graft and repeated PTA of hemodynamically significant anastomotic stenoses. The second case treated with US-guided aspiration has demanded repeated reinterventions due to recurrence; nevertheless, the result is satisfactory. In the last instance, the cyst was evacuated and excised. Six months after the surgery the patient is symptom-free and without signs of recurrence. CAD of the popliteal artery is a rare vascular condition. However, it must be considered in the differential diagnosis, especially in middle-aged male patients without evidence of atherosclerotic disease in whom intermittent claudication has developed suddenly with a rapid progression or with fluctuation in severity. Duplex ultrasound and MRA are the the best diagnostic methods. Based on the existing knowledge, the treatment of choice is surgery (either evacuation with the removal of the cystic wall or resection and grafting).

Highlights

Cystic adventitial disease is a rare vascular condition that causes localised stenosis or occlusion
The condition is predominantly located in the popliteal artery but other investigators have reported involvement of the external iliac[3,4], common femoral[5,6,7,8], axillary[9], distal brachial[2], radial and ulnar arteries[10,11]
Veins can be affected, e.g. the common femoral, popliteal or the great saphenous vein of the ankle[12,13,14], but the number of cases is 20 times lower than that associated with arteries[15]

Summary

Introduction

Cystic adventitial disease is a rare vascular condition that causes localised stenosis or occlusion. CAD is most common in male subjects, with a male-to-female ratio of 5:1 It usually manifests in the 4th or 5th decade of life and is mostly unilateral even though a few cases of bilateral involvement[16,17] and of the occurrence in very young[18,19,20] and old patients[21,22] have been reported. The incidence of CAD is estimated to be in 1200 cases of claudication This disease was first described in 1947 by Atkins and Key[3], in a patient with CAD that affected the external iliac artery. The purpose of this report is to summarise the current knowledge of the etiology, presentation, diagnostics and treatment of this condition, with the addition of new cases

Objectives

Results

Conclusion