Venous Adventitial Cystic Disease: A Review of 45 Cases Treated Since 1963

Abstract

Purpose. To review and identify the most accurate ways of diagnosing and treating adventitial cystic disease (ACD) of the venous system. Methods. Cases of ACD were collected through three popular medical databases, including PubMed, Cochrane, OVID, and MEDLINE. After reviewing the literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and all cases of arterial ACD were excluded. The clinical features, treatment, and subsequent course of 45 cases of venous ACD are included in this paper. Results. After reviewing all 45 cases of venous ACD , we have confirmed that the most common vessel affected is the common femoral vein, which reproduces the most common symptom of venous ACD: asymmetric lower extremity swelling worsening over time. Conclusion. Venous ACD most commonly affects the common femoral vein. When unilateral leg swelling occurs with or without a noticeable mass, ACD should be considered. It is best confirmed with CT venography and the treatment of choice is transluminal cyst evacuation and excision.

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

“…The condition is often misdiagnosed as deep vein thrombosis (DVT), femoral aneurysm, venous tumor, or lymphadenopathy. Bascone et al [ 3 ] performed a collective review of 45 cases of venous ACD for 50 years (from 1963 to 2016). Based on the results, the most common site was the femoral vein (56%), followed by the EIV (24%), saphenous vein and others (13%), and popliteal vein (7%).…”

“…This theory cannot explain cyst recurrence after complete cyst excision and within bypass grafts and rapid recurrences within a few months. Furthermore, the mean age of the patients was reported to be 47 years [ 3 ], and it is hard to believe that the ectopic synovial cells suddenly activate and secrete mucin after a long silent period of over 40 years. And this disease was observed only in one patient from the pediatric age group.…”

“…Colombier et al [ 27 ] advocated for percutaneous CT-guided aspiration as the initial treatment option for small cysts. However, they recommended close long-term follow-up to detect recurrence, and the recurrence rates are high due to viable mucin-secreting mesenchymal cells left in situ or remnant joint connection of the cyst wall [ 3 ]. Therefore, simple aspiration is not recommended.…”

“…The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral vein (CFV) and external iliac vein (EIV) have been reported [ 3 ].…”

Long-term follow-up of adventitial cyst surgical excision in external iliac vein

“…1 A literature review described a 45-case collection of venous ACDs reported from 1947 to 2016. 2 We describe a patient with venous ACD of the external iliac vein (EIV) who underwent surgical treatment. Written informed consent was obtained from the patient for publication of this case report and accompanying images.…”