Cystic adventitial disease of the popliteal artery: Diagnosis and treatment

Tsolakis, Ioannis A.; Walvatne, C.S.; Caldwell, Michael D.

doi:10.1016/s1078-5884(98)80175-5

Cited by 75 publications

(75 citation statements)

References 34 publications

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“…Flanigan, et al reported that simple evacuation of the cyst is the preferred treatment unless the process has progressed to chronic occlusion and thrombosis, in which case a bypass is preferred. 6) It was reported that the initial success rate of surgical resection was approximately 95%, 7,8) and that the risk of recurrence was rare after surgery. In cases where communication with the adjacent joint is noted preoperatively, the connections should be ligated for preventing recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…9,10) However, it was reported that the initial success rate of image-guided percutaneous cyst aspiration was much lower than that of surgery. 7,9) The failure of image-guided aspiration may attributed to incomplete aspiration due to high viscosity of the cyst content. Further, as the cyst is not resected in image-guided aspiration, the residual cystic wall can continuously secretes mucinous fluid and result in recurrence.…”

Section: Discussionmentioning

confidence: 99%

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A Case of Adventitial Cystic Disease of the Popliteal Artery Progressing Rapidly after Percutaneous Ultrasound-guided Aspiration

Seo

Fujii

Aoyama

et al. 2014

Annals of Vascular Diseases

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Adventitial cystic disease is a rare non-atherosclerotic vascular disease. We report a 36-year-old man with right intermittent claudication by adventitial cystic disease. computed tomography (CT) and magnetic resonance imaging (MRI) revealed an ovoid cystic mass compressing the right popliteal artery and causing severe stenosis of the lumen. Percutaneous aspiration was performed, which improved his symptoms. However, he complained of identical intermittent claudication two weeks later. Radiographic findings revealed that the cystic lesion had progressed rapidly. The cystic lesion was resected and the affected arterial segment was interposed. We consider that conventional surgical intervention remains the favored treatment option in the management of adventitial cystic disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Case of Adventitial Cystic Disease of the Popliteal Artery Progressing Rapidly after Percutaneous Ultrasound-guided Aspiration

Seo

Fujii

Aoyama

et al. 2014

Annals of Vascular Diseases

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“…The Ishikawa's sign can be seen in CAD, which is the disappearance of the foot pulses with flexion of the knee. This differentiates CAD from the popliteal entrapment syndrome, where the pulse would disappear with contraction of the gastrocnemius during active plantar flexion or passive dorsiflexion of the foot (15). Claudication symptoms in CAD can be transient and may resolve spontaneously (16).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…There are several different appearances of the affected vessels on angiography, such as eccentric narrowing of the lumen (scimitar sign), hourglass narrowing of the lumen, or complete occlusion. Lack of post-stenotic dilatation is a useful sign in CAD (15). However, some cases can have nonspecific complete luminal obstruction during angiography which can be mistaken for an endoluminal lesion (18).…”

Section: Diagnostic Imagingmentioning

confidence: 99%

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Cystic adventitial disease—case series and review of literature

Li¹,

King²,

Velasco³

et al. 2017

Ann. Transl. Med.

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Cystic adventitial disease (CAD) is a rare vascular disorder that involves the arteries and rarely the veins, most commonly found in the popliteal artery of male patients. Etiology of CAD is uncertain and currently without a consensus agreement. Clinically, the most common presenting symptom is claudication.Diagnosis requires a strong clinical suspicion in patients with intermittent claudication, but without other risk factors for atherosclerotic disease. Angiography, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used for diagnosis. Treatment of CAD can be done via surgical resection or percutaneous intervention such as aspiration. CAD can rarely recur after treatment. Case presentation Case 1A 54-year-old male who presented after an abnormal ultrasound (US) with Doppler exam at an outside institution with a 2 months history of new, progressive right leg claudication. His medical history is significant for hypertension and a maternal history of fatal abdominal aortic aneurysm rupture. The patient states a history of trauma to the right knee of uncertain nature. He denies illicit drug use but confirms a long history of cigarette smoking. Review of systems is otherwise negative. On physical examination, no swelling, varicose veins or stiffness in the right leg were identified. The right pedal pulses were palpable but greatly reduced. The left leg is unremarkable. The initial abnormal Doppler US performed at an outside institution (image not available) reported a 1.5 cm right popliteal artery aneurysm with a possible dissection within this aneurysm and luminal narrowing. An urgent computed tomography angiography (CTA) abdomen and pelvis with runoff was performed which demonstrated a cystic structure intimately associated with the right above-theknee popliteal artery, causing near complete occlusion (Figures 1,2) without evidence of dissection. A presumptive diagnosis of cystic adventitial disease (CAD) is made at this time, and the patient was taken to the operating room for definitive diagnosis and management. A posterior surgical approach was taken and a cyst in the wall of the right popliteal artery was identified. The cyst was entered with the evacuation of viscous, jelly-like amber material. The entire cyst wall was resected. There was strong distal popliteal artery pulse status post cystectomy. The patient had an unremarkable recovery. Follow up with Doppler US performed at 2 and 4 months post-cystectomy showed a normal right popliteal artery, without evidence of cyst recurrence. Case 2A 58-year-old male developed an acute onset of left lower extremity claudication and numbness. There were no resting pain, skin ulcerations or prior history of claudication symptoms. On physical examination, the patient's right lower extremity pulses were within normal limits. The left lower extremity pedal pulses were palpable but reduced, and became nonpalpable with left knee flexion (positive Ishikawa sign). A Doppler US demonstrated an anechoic lesion intimately associat...

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