Isquemia crítica em membro inferior em paciente jovem com doença cística de artéria poplítea

Abstract

The patient is a 45-year-old male physician, non-diabetic, non hypertensive, non-smoker and athlete, who was admitted to the Emergency Room complaining of severe pain on the left lower limb for 4 hours, decreased temperature, absence of left popliteal and distal pulse, accompanied by decreased sensitivity in the left foot, but with the motor function preserved. The patient reported bilateral calf intermittent claudication that had began one year earlier and had worsened to approximately 120 m in the last days.Ankle-brachial index (ABI) measurements showed an, ABI=0.40 at the left and ABI=0.85 at the right lower limb. Color Doppler ultrasound showed a thrombosed left popliteal artery aneurysm and approximately 50% stenosis of the right popliteal artery (Figures 1 and 2). The physician performing the examination raised the suspicion AbstractCystic adventitial disease of the popliteal artery is a rare vascular disease of unknown etiology in which a mucin-containing cyst may compromise the artery and, because of the compression, develops stenosis or occlusion of affected artery. We report the case of a 45-year-old male with cystic adventitial disease of the left popliteal artery, after admission for an acute limb ischemia in his left leg, diagnosed non-invasively with EcoDoppler vascular dual scan, magnetic resonance angiography, angiography. Performed complete removal of the cyst with arteriectomy and venous replacement. The pathologic result ware consistent with the diagnostic of cystic adventitial disease. The patient is in ambulatory follow up and was affected by cystic disease in the contralateral limb. The authors described the best methods of diagnosis and treatment for cystic adventitial disease, discussing if the urgency procedure was the most appropriate and whether there was an alternative treatment for the case. Finally, questioning what would be the best procedure to be performed in the other limb.Keywords: intermittent claudication; cyst; popliteal artery. ResumoDegeneração cística da artéria poplítea é uma doença vascular rara, de etiologia desconhecida, na qual um cisto com conteúdo mucinoide compromete a artéria e desenvolve estenose ou oclusão do vaso. Apresentamos um caso de um paciente do sexo masculino, 45 anos, admitido na emergência hospitalar, que apresentava quadro de isquemia aguda no membro inferior esquerdo. Submetido à EcoDoppler, angiorressonância magnética e angiografia pré-operatória. Realizada arterectomia com enxerto fêmoro-poplíteo infrainguinal de safena invertida. O exame patológico foi consistente com o diagnóstico de doença cística da artéria poplítea. O paciente encontra-se em acompanhamento ambulatorial e foi acometido pela doença cística no membro contralateral. Os autores descreveram os melhores métodos de diagnóstico e tratamento para a doença, discutindo se o procedimento de urgência foi o mais adequado e se haveria opções terapêuticas alternativas para o caso, além de qual seria a melhor conduta a ser realizada no membro contralateral também acometido pela doença.Palavra...

Doença cística da adventícia na veia basílica: relato de caso

“…2,3 The majority of reports in the literature describe cases in arteries. 4,5 Cystic adventitial disease of veins is extremely rare. 1 We were unable to locate any reports of cases of cystic adventitial disease involving veins of the upper limbs.…”