Cystic Adventitial Disease Research Articles

Adventitial cystic disease of the popliteal artery — A case for intraoperative duplex scanning

Adventitial cystic disease of the popliteal artery — A case for intraoperative duplex scanning

Popliteal Artery Occlusion Secondary to Cystic Adventitial Disease: A Rare Etiology of Lower Extremity Ischemia in a Marathon Runner

A 44-year-old marathon runner was referred with a 2-week history of the sudden onset of severe left calf claudication. Angiography showed a 3- to 4-centimeter focal nearocclusion of the left midpopliteal artery. Magnetic resonance imaging showed a cystic structure in the left popliteal artery wall. A left popliteal artery exploration revealed popliteal artery occlusion secondary to cystic adventitial disease. Excision of the cyst resulted in restoration of pedal pulses. This rare disease of uncertain etiology should be suspected in young adults presenting with ischemia. Various noninvasive techniques in conjunction with arteriography result in reliably diagnosing cystic adventitial disease. Excision of the cyst usually provides adequate treatment. Resection of the diseased arterial segment with autogenous bypass may be required.

Adventitial cystic disease of the popliteal artery communicating with the knee joint: A case report

We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery. (J Vasc Surg 1998;28:738-41.)

Adventitial cystic disease: A unifying hypothesis

Purpose: Six cases of adventitial cystic disease were studied, and the existing theories of the aetiology of adventitial cystic disease were reviewed to present evidence in support of a variation of the developmental hypothesis that might explain the sites of occurrence of this rare condition. Methods: Cases of adventitial cystic disease were collected by interrogation of the records of a group of vascular surgeons in the Johannesburg area. After reviewing the relevant literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and the theories of the formation of adventitial cystic disease were reviewed. The embryological origin of those vessels in which adventitial cystic disease occurs was investigated. Clinical cases were collected in private practice vascular referral centers. The clinical features, treatment, and subsequent course of six cases of adventitial cystic disease (four related to the popliteal artery, one in the femoral artery, and one in the radial artery) are included. Results: All cases of adventitial cystic disease reported have occurred in the nonaxial arteries, which form at a later stage than the axial vessels during limb differentiation and development. It is therefore postulated that during limb bud development cell rests derived from condensations of mesenchymal tissue destined to form the knee, hip, wrist, or ankle joints are incorporated into the nearby and adjacent nonaxial vessels during development of these vessels in the 15–22-week stage. These newly forming nonaxial vessels develop from vascular plexuses during the same stage of development, and in close proximity to the adjacent condensing joint structures. It is further postulated that these cell rests are then responsible for the formation of adventitial cystic disease later in life, when the mucoid material secreted results in a mass lesion within the arterial or venous wall. Conclusion: There is evidence supporting the hypothesis that adventitial cystic disease is a developmental condition occurring in the nonaxial blood vessels. (J Vasc Surg 1998;28:193-205.)

Cystic adventitial disease

A 23-year-old female presented with a five-week history of left calf claudication at 100 yards. She had palpable pedal pulses. Her resting ABI was 1.23 on the right and 0.88 on the left, post-exercise were 1.32 (R) and 0.58 (L). An angiogram showed a stenosis in her left popliteal artery with an otherwise normal arterial system (Fig. 1). A magnetic resonance angiogram was carried out and revealed an intramural swelling in the left popliteal artery extending for 3-4 cm (Figs 2, 3) which was compressing the lumen. The MR suggested that the content of the swelling was fluid. There was no evidence of popliteal artery entrapment. The artery was explored through an S popliteal incision. Incision in the adventitial layer caused clear viscid material typical of ganglion content to exude from the vessel wall. A thin strip of cyst wall was excised but the intima was not incised. Distal arterial pressures re turned to normal. A few hours following surgery there was haemorrhage from the wound and the patient was re turned to theatre. She was found to have bleeding from the affected area with a number of perforations at the site of previous cyst wall excision. The artery was opened and half the circumference of the affected segment was excised. Repair was with a vein patch using short saphenous vein. Postoperatively there were no problems and she made an uneventful recovery. On follow-up she was asymptomatic and post-exercise ABI's were normal.

Noninvasive vascular imaging in the diagnosis and treatment of adventitial cystic disease of the popliteal artery

This brief case report describes the successful outcome after surgical excision of multiple adventitial cysts of the popliteal artery in a 75-year-old man with rapidly worsening claudication. It highlights several unsettled points concerning the diagnosis, cause, and management of cystic adventitial disease of the popliteal artery and compares duplex ultrasound, computed tomography, and magnetic resonance angiography in the noninvasive diagnosis and treatment of this condition. (J Vasc Surg 1997;26:715-20.)

21.17 A case of cystic adventitial disease of the femoral artery

21.17 A case of cystic adventitial disease of the femoral artery

Adventitial Cystic Disease of the Popliteal Artery: Percutaneous US-Guided Aspiration

Adventitial Cystic Disease of the Popliteal Artery: Percutaneous US-Guided Aspiration

Adventitial cystic disease of the popliteal artery: percutaneous US-guided aspiration.

To evaluate percutaneous ultrasound (US)-guided aspiration as an alternative therapy for adventitial cystic disease. Between September 1993 and June 1996, seven patients (six men, one woman; age range, 42-62 years; mean age, 48 years) presented with symptomatic adventitial cystic disease of the popliteal artery (one patient with subacute foot paresthesia, six patients with chronic calf claudication). Color Doppler sonography showed stenosis due to eccentric cysts. Five of the patients also underwent digital subtraction angiography, and four patients underwent magnetic resonance imaging. With real-time sonographic guidance, a 14-gauge needle was forwarded percutaneously into the cysts for aspiration. The aspiration procedure was performed on an outpatient basis with local anesthetics. The procedure was technically and clinically successful in all cases. No complications were noted. Follow-up color duplex sonography performed between 1 and 32 months (mean, 14.8 months) after the procedure showed no relevant recurrent stenosis. Percutaneous US-guided aspiration is an easy, safe, efficacious method for treating adventitial cystic disease. In symptomatic patients who do not have thrombotic occlusion, it may be considered the treatment of choice.

Popliteal vascular disease: evaluation with spiral CT angiography.

To evaluate the potential role of spiral computed tomographic (CT) angiography in the diagnosis of popliteal artery disease. In 26 consecutive patients referred for popliteal arteriography, the authors performed additional spiral CT angiography with the following protocol: 3-5-mm collimation, 4-6 mm/sec table speed, and 2-3-mm overlap during 32 seconds, with use of 110 mL of contrast medium. Axial transverse sections and shaded surface display and multiplanar reformation reconstruction images were analyzed. All patients underwent previous Doppler ultrasound examination. In the 52 arteries imaged, arteriography showed 14 isolated hemodynamically significant (>50% diameter reduction) stenoses (due to popliteal artery entrapment in one case), four occluded arteries, and 11 aneurysms. CT angiography also demonstrated these 14 stenoses and four occlusions. However, axial transverse views at CT angiography showed that eight of the stenoses were associated with other abnormalities (aneurysm in six, popliteal artery entrapment syndrome in one, and cystic adventitial disease in one) and that two of the occlusions resulted from popliteal artery entrapment syndrome (n = 1) and thrombosis of an aneurysm (n = 1). CT angiography also demonstrated the 11 aneurysms shown with arteriography. Popliteal artery lesions can be diagnosed with spiral CT angiography, which provides detailed information on the wall and diameter of the artery and relation of the artery to adjacent structures.

Cystic Adventitial Disease of the Popliteal Artery

Cystic Adventitial Disease of the Popliteal Artery

MR Imaging of cystic adventitial disease of the popliteal artery: 2 cases

MR Imaging of cystic adventitial disease of the popliteal artery: 2 cases

A CASE OF CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY

A rare case of cystic adventitial disease of the popliteal artery in a 42-year-old man is reported. He was admitted to our hospital suffering from intermittent claudication. DSA showed a smooth extrinsic compression of the right popliteal artery. At operation, a cystic adventitial lesion of the right popliteal artery, measuring 2×3cm, was surgically removed. The postoperative course was uneventful and all symptoms disappeared.

Cystic Adventitial Disease of the Popliteal Artery Demonstrated by CT & MR Imaging: A Case Report

Cystic Adventitial Disease of the Popliteal Artery Demonstrated by CT & MR Imaging: A Case Report

Cystic Adventitial Disease of the Popliteal Artery Demonstrated with Intravascular US

Cystic Adventitial Disease of the Popliteal Artery Demonstrated with Intravascular US

Demonstration of cystic adventitial disease by intravascular ultrasound imaging

In a 34-year-old woman with intermittent calf claudication, cystic adventitial disease of the popliteal artery was demonstrated by intravascular ultrasound imaging. Multiple intramural cystic masses were seen to be compressing the arterial lumen. The diagnoses of cystic adventitial disease was confirmed by surgery. Intravascular ultrasound imaging reliably identifies cystic adventitial disease; its application can be recommended as an alternative to established diagnostic procedures (computed tomography, magnetic resonance imaging) in patients undergoing angiography.

Regarding "A case of cystic adventitial disease of the popliteal artery demonstrated by magnetic resonance imaging"

Regarding "A case of cystic adventitial disease of the popliteal artery demonstrated by magnetic resonance imaging"

Adventitial cystic disease: Multiple cysts causing common femoral artery occlusion

Adventitial cystic disease is an unusual cause of acute arterial insufficiency. The artery most commonly affected is the popliteal arter~ over 200 cases having been reported between 1954 and 1991.1'2 It has been detected far less frequently in other arteries including the radia l ulnar, external iliac and common femoral arteries. 3,4 A case of two cysts, one in the profunda femoris and the other in the superficial femoral arter~ is reported. pedis and posterior tibial pressures of 95 m m and 100 m m H g respectively. Angiography showed a localised occlusion of the distal right common femoral artery at the origins of both the superficial femoral and profunda femoris arteries. These reconstituted via short collaterals from

Critical ischaemia complicating cystic adventitial disease of the popliteal artery

Cases of cystic adventitial disease of the popliteal artery are presented to highlight the level of alertness necessary to recognise the characteristic clinical history of this uncommon condition before it progresses to critical limb ischemia when expeditious investigation and surgery are necessary to salvage the limb.

A case of cystic adventitial disease of the popliteal artery demonstrated by magnetic resonance imaging

In a 45-year-old man, who was free of symptoms after a 312-month period of calf claudication, a diagnosis of cystic adventitial disease was confirmed by magnetic resonance imaging. At operation a 12 cm long intramural cyst of the popliteal artery, continuous with a cyst around a genicular arterial branch, was found. Total resection of the cyst and its branch was performed. We recommend computed tomography or magnetic resonance imaging as the diagnostic tools of first choice in young patients who are free of arteriosclerosis and who have episodes of intermittent claudication of the calf.