Cystic adventitial disease of the popliteal artery

Abstract

A 53-year-old man presented with intermittent claudication of his right leg and a painless walking distance of about 120 meters. On examination there were no stigmata of generalized arterial disease. The peripheral pulses were present with the limb extended but disappeared during knee joint flexion. Color-coded Doppler sonography resulted in the diagnosis of a high-grade stenosis of the supragenicular popliteal artery, which was confirmed by magnetic resonance angiography (Figure 1), demonstrating the scimitar sign, a curvilinear defect marking an eccentrically located, smoothly demarcated stenosis in an otherwise normal artery. Axial magnetic resonance imaging (Figure 2) revealed a cystic lesion (straight arrows) nearly occluding the popliteal arterial lumen (curved arrow). The high signal intensity on T1-weighted images suggested a rather high protein content of this lesion. Because of the typical location and clinical signs, cystic adventitial disease was suspected. At operation, after the popliteal artery had been exposed via a posterior approach, cystic advential disease was confirmed by the presence of its pathognomonic features. The arterial caliber showed a circumscribed enlargement, from which, on longitudinal incision, a yellowish-colored, pressurized, gelatinous, viscid, mucoid mass escaped (Figure 3). The adventitial layer was completely resected, preserving the arterial continuity and thereby restoring flow (Figure 4). No connection with the knee joint could be demonstrated in this case. After an uneventful postoperative course the patient is free of symptoms with a follow-up of 28 months.