How to explain cystic adventitial disease coexisting in an adjacent artery and vein

Cystic adventitial disease of the common femoral vein: A case report

“…ACD was first reported in 1947 by Atkins and Key (3), but ACD of the arteries is more frequent in men, it is predominantly located in the popliteal artery and it clinically presents with intermittent claudication (2). However, ACD of the venous system is a very rare condition, with fewer than 20 cases reported in the worldwide literature (4)(5)(6)(7)(8).…”

“…The arterial variety of ACD has often been described in the popliteal artery (1). Patients with this disease will have severe swelling, tenderness, and pain (2). In this report, we discuss the case of a 62-year-old woman who presented with a swollen lower leg secondary to obstruction of the common femoral vein.…”

“…The venous variety occurs with an equal frequency in both sexes and it most often involves the common femoral vein and causes swelling of the affected limb (2).…”

An anatomic explanation for combined so‐called adventitial/intraneural cysts

“…In a previous submission (Prasad et al, 2015), we suggested that a fascial sheath surrounding blood vessels might act as a common conduit for an adventitial cyst to propagate from a neighboring joint, potentially explaining the finding of cystic adventitial disease with two separate cysts affecting concomitantly the arteries and veins of the popliteal (Ohta et al, 1984) and iliofemoral vessels (Alioti et al, 2005) in two patients. Review of more than 700 examples of intraneural ganglion cysts in the world's literature revealed a unique case that further develops this idea-a 50 year old woman with a tibial neuropathy was found to have a single cyst in the distal popliteal fossa encompassing the posterior tibial artery and vein as well as the tibial nerve, giving rise to a combination of so-called adventitial and intraneural cysts (Park et al, 2013).…”

“…2). The first theory involves sequential spread of cyst from the combined capsular artery and vein sheath (as described previously (Prasad et al 2015)) to engulf the tibial nerve and popliteal vessels. A potential variation that is less likely, in our opinion, would be progression toward the common fascial sheath around the parent neurovascular bundle via an articular branch of the tibial nerve.…”