Cystic Adventitial Disease of the Popliteal Artery With Recurrent Intermittent Claudication After Drug-Coating Balloon Angioplasty: A Case Report Treated by Surgical Treatment.

Shinichi Tanaka,Jin Okazaki,Kiyoshi Tanaka

doi:10.7759/cureus.23190

Abstract

Cystic adventitial disease of the popliteal artery is a rare cause of unilateral intermittent claudication. The etiology of cystic adventitial disease is unknown, and affected patients are younger than those diagnosed with chronic arteriosclerosis. A 62-year-old man presented with a history of right leg claudication, which occurred after walking a distance of 500 m. The patient had no history of cardiovascular risk factors or trauma in the lower extremities. The ankle-brachial pressure index (ABI) was 0.58 in the affected leg. The patient was referred to the cardiovascular department. On Doppler ultrasonography, popliteal artery stenosis was detected. Following an angiogram, drug-coated balloon angioplasty was performed. The claudication improved, as indicated by an ABI of 1.11 in the affected leg. However, following one month of endovascular treatment, claudication had recurred, indicated by an ABI of 0.59. Computed tomography indicated the presence of a stenotic lesion in the popliteal artery, which may have developed from compression on the artery due to the presence of a surrounding periarterial cyst. The patient was subsequently diagnosed with cystic adventitial disease of the popliteal artery and was referred for vascular surgery. During surgery, the popliteal artery was exposed by the posterior approach; the artery showed circumferential enlargement and complete resection of the adventitial layer was performed. The patient had a successful postoperative recovery and the claudication disappeared (ABI of 1.14). Surgical management is an effective curative treatment for cystic adventitial disease of the popliteal artery that shows better efficacy than endovascular treatment. In the future, diagnostic methods for cystic adventitial disease should include computed tomography or magnetic resonance imaging with T1- and T2-weighted images.

Highlights

Cystic adventitial disease of the popliteal artery leads to a rare cause of unilateral calf claudication [1]
How to cite this article Tanaka S, Tanaka K, Okazaki J (March 15, 2022) Cystic Adventitial Disease of the Popliteal Artery With Recurrent Intermittent Claudication After Drug-Coating Balloon Angioplasty: A Case Report Treated by Surgical Treatment
The computed tomography (CT) findings indicated that the affected right popliteal artery was compressed by a non-enhancing structure that surrounded the arterial wall (Figure 3), and the patient was diagnosed with cystic adventitial disease of the popliteal artery and referred to our department

Summary

Introduction

Cystic adventitial disease of the popliteal artery leads to a rare cause of unilateral calf claudication [1]. Following treatment, the claudication symptoms improved, and the ABI was recorded as 1.11 in the affected leg. How to cite this article Tanaka S, Tanaka K, Okazaki J (March 15, 2022) Cystic Adventitial Disease of the Popliteal Artery With Recurrent Intermittent Claudication After Drug-Coating Balloon Angioplasty: A Case Report Treated by Surgical Treatment. The CT findings indicated that the affected right popliteal artery was compressed by a non-enhancing structure that surrounded the arterial wall (Figure 3), and the patient was diagnosed with cystic adventitial disease of the popliteal artery and referred to our department. CT image showing cystic adventitial disease of the popliteal artery. The patient did not complain of any recurrence of claudication or discomfort in the affected leg

Discussion

Conclusions

Disclosures