Surgical Strategy to Reduce the Recurrence of Adventitial Cystic Disease after Treatment

Abstract

PurposeAdventitial cystic disease (ACD) is a rare condition that causes intermittent claudication and non-atherosclerotic disease without cardiovascular risk factors. The etiology and optimal treatment of ACD remain controversial. The purpose of this study was to analyze surgical treatment results for ACD and to elucidate optimal treatment options.Materials and MethodsWe retrospectively reviewed 30 patients with ACD who underwent surgery from 2006 to 2018. Twenty-two patients had arterial ACD, six had venous ACD, and two had combined venous and arterial ACD. We reviewed demographic and clinical characteristics, treatment details, and procedure outcomes.ResultsRecurrence occurred in 6 cases either after cyst excision alone (4/17) or patch angioplasty (2/2). There was no recurrence after vessel excision with interposition grafting (0/7). Therefore, vessel excision was a statistically significant factor in recurrence prevention (P=0.026). Among the six recurrences, joint connections of the cystic lesions were found in four of the six (66.7%).ConclusionAs a curative surgery for ACD, vessel excision with interposition grafting is a better strategy to prevent recurrence than simple cyst excision alone.

Inconsistent Use of Terminology and Different Treatment Outcomes of Venous Adventitial Cystic Disease: A Proposal for Reporting Standards

“…Only 12 cases of venous ACD among Korean patients have been reported based on 14 articles found in PubMed and KoreaMed [ 1 , 7 , 10 - 21 ]. The mean age of the patients was 49.6 (range, 32-69) years.…”

“…Interestingly, three-fourths of these recurred patients were initially treated more aggressively with cyst excision and patch angioplasty, and only one patient who underwent complete cyst excision had recurrence. All patients treated with excision and patch angioplasty presented with recurrence (Table 1) [ 1 , 7 , 10 - 16 ]. This paradox raises serious questions doubting the heterogeneity of terminology and dubious diagnosis in the reported cases.…”

“…This method is more extensive than exarterectomy. However, several cases of recurrence after these surgeries were reported [ 1 , 30 ]. In iliofemoral ACD, the joint connection is usually located on the posterior wall beneath the inguinal ligament.…”

“…The role of preoperative localization of the joint connection and optimal surgical approach must be discussed. Thus, disobliteration of the joint connection may be the key to prevent recurrences in iliofemoral venous ACD [ 1 ].…”

“…In a recent issue of Vascular Specialist International , Lim et al [ 1 ] presented a surgical strategy that can reduce the recurrence of adventitial cystic disease (ACD) after treatment. ACD is a very rare disease characterized by the accumulation of a cyst filled with gelatinous mucinous substance, similar to the joint fluid, particularly in the adventitia of a vessel adjacent to the joint area [ 2 ].…”