Successful Diagnosis and Treatment of a Case of Arterial Adventitial Cystic Disease (ACD)

Abstract

PurposeArterial adventitial cystic disease (ACD) is a rare type of non‐atherosclerotic peripheral vessel disease which results in intermittent claudication. There has been only a few cases reported in the past 50 years and its pathogenesis has been poorly understood. In ACD, it is the challenging goal of surgeons to reach a quick and correct diagnosis operation. A series of observations and treatment in one case of typical ACD were conducted to better understand the development and the diagnostic procedure of ACD.MethodsA 55‐year‐old female patient visited the hospital with a complaint of claudicating on the right lower extremity that had begun three months earlier. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) was performed for exact diagnosis. Tissue samples obtained from surgeries were observed histopathologically.ResultsThe patient was admitted in hospital for suspecting occlusive artery on right lower extremity based on a physical examination and CTA and the treatment plan for arterial occlusion was stent placement. After carefully reviewed the result of CTA, the authors found the intima of popliteal artery was smooth and a mass with uniform density could be seen near the adventitia. Digital subtraction angiography (DSA) was further performed for exact diagnosis and the result indicated adventitial cystic disease as well. Thus, a cystic mass excision was performed. Stent‐graft bypass implantation was performed because the cyst was 8cm long which was not fit for partial excision repair. In the end, a cystic mass obtained from surgeries were observed histopathologically and final ACD diagnosed based on the macroscopic findings. The patient was recovered and the claudicating on the right lower extremity was resolved.ConclusionsArterial adventitial cystic disease is a rare type of non‐atherosclerotic peripheral vessel disease. It could be misdiagnosed as occlusive artery and stent placement would aggravate the condition. Therefore, the diagnosis is critical for ACD and the cystic mass excision must be performed.