Obstruction of popliteal artery by synovial cyst report of a case

Abstract

months he was reduced by pain to cease walking after zoo yards on the flat. Medical treatment gave no results, and surgery was sought in September, 1959. He had worked as a plasterer from 1945 to 1956, and again during the second half of 1958 for six months. In the latter period, almost up to the onset of the pain, he had worked on floors, kneeling on his right knee. The same applied to about 25 per cent of his time in the I r-year period. Since the pain he had driven a small truck around a timber yard.He was a robust man; he had smoked an average of 4 02. of cigarette tobacco per week for the previous eighteen years. There were no cardiac symptoms and the E.C.G. was normal. All pulses were palpable, including right popliteal, posterior and anterior tibials, the latter three being markedly diminished. There were no trophic changes in the toes and feet, but after exercise the right toes and foot would become numb and white.AT OPERATION. -The right femoral arteriogram showed normal vessels with smooth walls, except for the upper popliteal where the lumen was reduced to a thread over I 4 in. by something encroaching from one side. The usual branches of the popliteal were outlined. At exploration a fusiform swelling of the popliteal artery was found bound alongside the artery, compressing it. Dense adhesion to adjacent veins was encountered, particularly at the lower end, but no connexion was made out with the knee-joint. The vessels arising from it were divided in turn until at the lower end a normal vessel was seen disappearing between the gastrocnemius heads. It

Cystic Adventitial Disease of the Popliteal Artery

“…It has also been described as a dilatation of the artery (Simon, 1963) as yellowish brown in colour (Ishikawa et al, 1961) and as a pulsatile lump (Lambley, 1963 ;Tytgat, Derom, and Galinsky, 1958). Dense periarterial adhesions similar to those found in Case 2 have been reported by other authors (Hiertonn et al, 1957;Robb, 1960;Tytgat et al, 1958;Ishikawa et al, 1961Bliss et al, 1963.…”

Compression syndromes of the popliteal neurovascular bundle due to Baker cyst

“…In rare instances in which the popliteal artery is compressed by the Baker cyst in a pulsatile fashion, the patient can experience lower extremity claudication due to intermittent ischemia to the limb. [21][22][23][24][25] The popliteal artery is deeper and stiffer than the vein, requiring higher force to produce compression, and so the incidence of this syndrome is least likely, especially in isolation of nerve or venous symptoms. None of the reported cases of arterial occlusion mentioned venous compression.…”

“…15 Popliteal vessel compression can also cause a true thrombophlebitic 18 or pseudothrombophlebitic syndrome, 19,20 and in rare cases of arterial compression, claudication of the lower extremity can occur due to intermittent ischemia. [21][22][23][24][25] The differential diagnosis for syndromes associated with compression of the neurovascular bundle include intraneural ganglion cyst of distal divisions of the sciatic nerve, [26][27][28] adventitial cyst of the popliteal artery, thrombophlebitic syndrome caused by DVT of the lower extremity, 18,[29][30][31][32] synovial sarcoma of the knee joint, popliteal entrapment syndrome, posterior compartment syndrome of the lower leg, [33][34] popliteal artery aneurysm, and Baker cyst. A popliteal cyst may be comorbid with a number of these conditions, including communication of the cyst with an adventitial cyst of the popliteal artery, 35 development of a synovial sarcoma within the cyst, 36,37 and also rupture of the cyst, resulting in the acute development of a compartment syndrome.…”

Arterial cystic degeneration

“…In those arteries that have been resected, the histological picture varies. In three specimens the cyst was a large sac-like cavity confined to the adventitia, with no evidence of communication between the cystic formation and the arterial lumen (Ejrup & Hiertonn, 1954;Robb, 1960). The cyst wall itself consisted of a thin layer of dense fibrous tissue lined by a single layer of flattened endothelial cells.…”

“…Bliss and his colleagues (1963) found the suddenness of the onset of symptoms difficult to explain, and suggest that a minute intramural dissection may give rise to arterial spasm, followed by an effusion in the arterial wall, which subsequently became mucoid. Robb (1960) suggested that the cyst was formed from a piece of synovial membrane either from a nearby tendon sheath or from the knee joint, which had become attached to the artery as a result of trauma or a developmental abnormality, and the argument has the support of Lewis and his colleagues (1967). Cystic degeneration of other arteries Cystic degeneration affecting the iliofemoral arterial system has now been reported seven times (Table 3), and all the cases except one have been men.…”