Cystic Adventitial Disease of the Popliteal Artery: Radical Surgical Treatment After Several Failed Approaches. A Case Report and Review of the Literature

Vento, Vincenzo; Faggioli, Gianluca; Ancetti, Stefano; Sonetto, Alessia; Dieng, Mortalla; Mirelli, Michele; Gargiulo, Mauro

doi:10.1016/j.avsg.2019.10.046

Cited by 11 publications

(22 citation statements)

References 37 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One theory proposes developmental theory where vessels adjacent to joints have mesenchymal cells that are eccentrically implanted during embryogenesis and secrete J o u r n a l P r e -p r o o f mucinous fluid later in life (1). Another proposes micro-trauma, as seen in healthy athletes involved in repetitive stretch injuries causing separation of the adventitia from the media resulting in adventitial cystic degeneration (6,7). The (de novo) systemic disorder theory also suggests degeneration of the adventitial layer and cyst formation due to a general connective tissue disorder.…”

Section: Discussionmentioning

confidence: 99%

“…The (de novo) systemic disorder theory also suggests degeneration of the adventitial layer and cyst formation due to a general connective tissue disorder. The articular or synovial theory proposes that ectopic synovial ganglions track along vascular branches from an adjacent joint capsule eventually implant into the adventitia (1,4,7,8). Both the developmental and synovial theory have gained support by evidence of a joint connection found intraoperatively between adventitia and adjacent joints in up to 66.7% of reported cases (1,2,9).…”

Section: Discussionmentioning

confidence: 99%

“… 1 Another theory proposes the occurrence of microtrauma, which can occur in healthy athletes involving repetitive stretch injuries, causing a separation of the adventitia from the media resulting in adventitial cystic degeneration. 6 , 7 The de novo systemic disorder theory also suggests degeneration of the adventitial layer and cyst formation due to a general connective tissue disorder. The articular or synovial theory proposes that ectopic synovial ganglions track along vascular branches from an adjacent joint capsule and eventually implant into the adventitia.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Cystic adventitial disease of the popliteal vein and artery in siblings

Chan¹,

Cornwall

Ilonzo

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cystic adventitial disease of the popliteal vein and artery in siblings

Chan¹,

Cornwall

Ilonzo

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

show abstract

“…Open surgery is regarded as the management of choice for CAD, with poor outcomes reported from endovascular approaches, despite some case reports of success in certain circumstances. 2,9,10 Similarly, we caution against primary endovascular intervention in PAD patients under 40 where the etiology is unclear. We hope that this report highlights the possibility of this rare phenomena to masquerade as an alternative diagnosis, and underscores CAD’s presence on the list of differential diagnoses for young patients who present with intermittent claudication without atherosclerotic risk factors.…”

Section: Discussionmentioning

confidence: 99%

Cystic Adventitial Disease Presenting as Occlusion of the External Iliac Artery: A Rare Manifestation

Lovelock

Dean

Mow³

et al. 2020

Vasc Endovascular Surg

View full text Add to dashboard Cite

Cystic adventitial disease (CAD) is a rare, non-atherosclerotic cause of peripheral arterial disease characterized by mucinous cyst formation in the adventitial layer of arteries; with approximately 80% to 90% of cases involving the popliteal artery. We describe a case of CAD presenting in a female with left external iliac artery occlusion and intermittent claudication, for whom an intra-operative diagnosis of CAD of the ilio-femoral segment was made. A 37-year-old mother-of-two was referred to a Vascular Surgeon with a 3 to 4-year history of progressive intermittent claudication. A computed tomography (CT) angiogram demonstrated a left external iliac artery occlusion. Given the location of the lesion, the absence of cardiovascular risk factors and the patient’s history of cycling, a diagnosis of left external iliac artery occlusion secondary to arterial endofibrosis or spontaneous arterial dissection was thought to be likely. A left Rutherford-Morrison incision was made and an extraperitoneal approach used to expose the left iliac system. A cyst was opened and marsupialized along the superior aspect of the external iliac artery, releasing gelatinous material. A provisional intra-operative diagnosis of CAD was made. The patient was systemically heparinized and an external iliac to common femoral artery bypass was performed using reversed ipsilateral greater saphenous vein. CAD primarily involves the popliteal artery. Under 40 cases of CAD with iliofemoral involvement have been reported. Our case is unusual given the location of CAD, as well as its occurrence in a female. Management options for similar cases have been described in the literature ranging from cyst excision and arterial patching, to interposition bypass and even exclusion bypass, in the case of longer segment occlusions. In our case, an exclusion bypass was deemed the most appropriate treatment given the extensive length and complete occlusion of the external iliac artery.

show abstract

“…For cystic adventitial disease treatment, different techniques have been described, We can make an aspiration of the cyst under computed tomography or ultrasound guidance if arterial permeability is preserved. [5][6][7] Endovascular treatment of cystic adventitial disease is still an attractive technique. However, early follow-up is marked by high recurrence rates.…”

mentioning

confidence: 99%

Cystic adventitial disease of the popliteal artery

Belmir

Tijani

Khloufi

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

View full text Add to dashboard Cite

A 47-year-old man was admitted for progressively worsening calf cramp in the right leg while walking. No risk factors for vascular disease were identified, apart from some degree of hypercholesterolemia. He had no history of trauma in the right leg, and he participated in regular physical activity. The ankle-brachial index was 0.6 on the right side and 1.0 on the left side. On examination, no popliteal and distal arterial pulses were present in the right leg, whereas this arterial pulses were present in the left leg. Duplex ultrasound examination and computed tomography scans performed 3 months after the onset of symptoms revealed a multilocular cystic formation within the right popliteal artery wall, determining a severe luminal stenosis. Therefore, a diagnosis of cystic adventitial disease was confirmed (A). In this case, a subsequent conventional angiography revealed a concentric compression of the popliteal artery by the cyst, with the characteristic hour glass sign (B). The therapeutic approach was surgical first. The patient was placed in a supine position and the great saphenous vein was removed from the right leg via internal access. Second, the patient was placed prone, and a posterior approach was realized through an incision in the popliteal fossa. A multilocular cyst was identified (C) and resected, followed by a popliteal bypass reconstruction with autologous great saphenous vein. Clinical follow-up was free of symptoms. He remains asymptomatic with normal peripheral pulses 0.3 years after surgery, with an ankle-brachial index of 0.9. Histopathology showed a multilocular cystic adventitial disease interesting the popliteal artery wall (D). This cyst was located between the media and adventitia of the artery. and contained gelatinous material. The patient (Mr M.B) agree to publish his case details and images, in all editions of the Journal of Vascular Surgery Publications and in any other publication, as well as in any advertising or promotional material for such product or publications. DISCUSSION Cystic adventitial disease is encountered predominantly in men, with an average male:female ratio of 15:1 and an incidence of 1:1200 in patients with claudication. 1 The etiology of cystic adventitial disease remains controversial. Four theories are proposed: degenerative, traumatic, synovial, and developmental. The adventitial cyst becomes incorporated into the vascular wall and its growth causes compression of the lumen. These cysts contain myxoid material rich in hyaluronic acid. 2 In our case, the diagnosis was confirmed using Doppler ultrasound examination and computed tomography imaging; other pathologies were excluded, such as popliteal aneurysms and extrinsic compression from Baker's cysts, 3,4 false aneurysms, and

show abstract

Cystic Adventitial Disease of the Popliteal Artery: Radical Surgical Treatment After Several Failed Approaches. A Case Report and Review of the Literature

Cited by 11 publications

References 37 publications

Cystic adventitial disease of the popliteal vein and artery in siblings

Cystic adventitial disease of the popliteal vein and artery in siblings

Cystic Adventitial Disease Presenting as Occlusion of the External Iliac Artery: A Rare Manifestation

Cystic adventitial disease of the popliteal artery

Contact Info

Product

Resources

About