Two Cases of Popliteal Cystic Adventitial Disease Treated with Primary Stenting: Long-Term Results

Cystic adventitial disease masquerading as ganglion disease: a rare cause of intermittent claudication

Cystic adventitial disease (CAD) is a rare cause of claudication in which a mucinous cyst forms within the adventitial layer of a blood vessel, most commonly the popliteal artery, resulting in luminal narrowing. This paper presents a case of a man in his mid-50s with unilateral lower limb popliteal artery CAD, which was not initially identified on either duplex ultrasonography or CT angiography. He was successfully treated with surgical resection of the affected segment of the popliteal artery and autologous vein grafting.

Cystic Adventitial Disease of the Popliteal Artery With Recurrent Intermittent Claudication After Drug-Coating Balloon Angioplasty: A Case Report Treated by Surgical Treatment

Cystic adventitial disease of the popliteal artery is a rare cause of unilateral intermittent claudication. The etiology of cystic adventitial disease is unknown, and affected patients are younger than those diagnosed with chronic arteriosclerosis. A 62-year-old man presented with a history of right leg claudication, which occurred after walking a distance of 500 m. The patient had no history of cardiovascular risk factors or trauma in the lower extremities. The ankle-brachial pressure index (ABI) was 0.58 in the affected leg. The patient was referred to the cardiovascular department. On Doppler ultrasonography, popliteal artery stenosis was detected. Following an angiogram, drug-coated balloon angioplasty was performed. The claudication improved, as indicated by an ABI of 1.11 in the affected leg. However, following one month of endovascular treatment, claudication had recurred, indicated by an ABI of 0.59. Computed tomography indicated the presence of a stenotic lesion in the popliteal artery, which may have developed from compression on the artery due to the presence of a surrounding periarterial cyst. The patient was subsequently diagnosed with cystic adventitial disease of the popliteal artery and was referred for vascular surgery. During surgery, the popliteal artery was exposed by the posterior approach; the artery showed circumferential enlargement and complete resection of the adventitial layer was performed. The patient had a successful postoperative recovery and the claudication disappeared (ABI of 1.14). Surgical management is an effective curative treatment for cystic adventitial disease of the popliteal artery that shows better efficacy than endovascular treatment. In the future, diagnostic methods for cystic adventitial disease should include computed tomography or magnetic resonance imaging with T1- and T2-weighted images.