The etiology and management of cystic adventitial disease

Cystic adventitial disease of the common femoral artery: a case report and overview of the literature

INTRODUCTION

Cystic adventitial disease (CAD) is an uncommon condition that affects arteries and veins. It can cause a rare type of non-atherosclerotic peripheral vessel disease. The most common vessel affected is the popliteal artery. The number of case reports on CAD of the femoral artery is growing. We present a case of a 62-year-old female presented with claudication of the left leg diagnosed with CAD of the left common femoral artery. The patient was treated surgically with cyst excision and vessel reconstruction with saphenous vein autograft patch plasty. After 8-months the cyste relapsed and she had new claudication complains. We decided to perform new surgery. Surgical treatment consisted of cyst resection by excision of the femoral bifurcation and saphenous vein autograft interposition reconstruction of the bifurcation. We also provide an update on the latest literature of surgical treatment of CAD of the ilio-femoral artery region.

METHODS

Medline and EMBASE were used to collect articles on CAD of ilio-femoral artery. We included English written or translated case reports or series between 1987 and 2023.

RESULTS

Twenty-nine patients out of 28 case reports were included. Most patients were male (59%). Claudication is the most common symptom (76%). Treatment consisted of cyst resection, cyst decompression, Endarterectomy, patch angioplasty and interposition graft using PTFE, Dacron, Great saphenous vein (GSV) or femoral vein autograft. Recurrence appeared in 4 cases (14%).

CONCLUSION

In accordance to the literature and our experience we recommend complete vessel excision and saphenous vein (or PTFE) interposition bypass as treatment.

Venous adventitial cystic disease is a very rare disease that can cause deep vein thrombosis: A case report

BACKGROUND

Venous adventitial cystic disease (VACD) is a rare disease characterized by cysts, filled with a gelatinous mucous substance similar to joint fluid, in the adventitia of blood vessels adjacent to the joints. It is often misdiagnosed as deep vein thrombosis (DVT), femoral varices, venous tumors, or lymphadenopathy.

CASE SUMMARY

A 69-year-old woman visited our hospital with a complaint of swelling in the right lower extremity. The patient was diagnosed with DVT and prescribed apixaban at an outpatient clinic. After 3 wk, the patient was hospitalized again because of sudden swelling in the right lower extremity. We diagnosed VACD and performed surgery for cyst removal as well as patch angioplasty and thrombectomy of the right common femoral vein. The patient received anticoagulants for 6 mo and has been doing well without recurrence for 1 year postoperatively.

CONCLUSION

Recurrent VACD requires complete removal of the connections to the joint cavity to prevent recurrence.

[Rare cause of calf pain in a 56-year-old female patient: cystic adventitial degeneration of the popliteal artery]

INTRODUCTION

Cystic adventitial degeneration (CAD) is a rare vascular disease, affects mostly middle-aged men, and as a nonatherosclerotic disease, is an uncommon differential diagnosis of intermittent claudication.

CASE HISTORY

A 56-year-old female patient presented to our medical office because of unexplained right-sided calf pain that was not constantly load-dependent. The complaints fluctuated considerably with longer symptom-free intervals.

EXAMINATION AND FINDINGS

Clinically, the patient presented regular pulses, which were maintained even with provocative maneuvers such as plantar flexion and knee flexion. Duplex sonography showed cystic masses around the popliteal artery. On MRI examination, a tubular tortuous connection to the knee joint capsule also appeared to be visualizable. A diagnosis of cystic adventitial degeneration was made.

THERAPY AND COURSE

In the absence of constant impairment of walking performance with symptom-free intervals as well as morphological and functional signs of stenosis, interventional or surgical therapy was not desired by the patient. Short-term follow-up revealed stable clinical and sonomorphologic findings over an observation period of 6 months so far.

DISCUSSION

CAD should also be considered in female patients with atypical leg symptoms. There are no uniform treatment recommendations for CAD, which is why it is a challenge to select the optimal, usually interventional procedure. In patients with few symptoms and no critical ischemia, a conservative approach with close follow-up may be justified, as in our case report.

Cystic Adventitial Disease of the Popliteal Vein: A Case Report

Venous cystic adventitial disease (VCAD) is a rare vascular anomaly located in the common femoral vein in most cases. We describe the case of a 59-year-old female patient with right leg edema who was misdiagnosed with deep vein thrombosis of the lower extremity at another hospital. Magnetic resonance angiography revealed a round mass in the popliteal vein, with a narrow lumen. Considering the location of the lesion, absence of a history of deep venous thrombosis and trauma, and clinical manifestations, the diagnosis is likely a popliteal vein adventitial cyst. Segmental popliteal vein resection and reconstruction were performed using a cylindrical great saphenous vein graft. No joint connection was found during the operation, and the postoperative pathology confirmed VCAD.

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.

Common femoral adventitial cystic disease in a young female patient

Adventitial cystic disease (ACD) is a rare condition that typically presents in young healthy men with symptoms of claudication. ACD is characterized by formation of a mucinous cyst within the adventitia of a blood vessel, usually in the popliteal artery, causing compression of the vessel's lumen and leading to reduced flow and symptoms of claudication. We have presented a rare case of ACD of the common femoral artery in a young female patient that was treated successfully with resection and femoral vein graft interposition reconstruction.

A remarkably rare case of Adventitial Cystic Disease of the Popliteal Artery in a 51-year-old Middle Eastern female - A Case Report

INTRODUCTION AND IMPORTANCE

Adventitial Cystic Disease (ACD) is a vastly rare non-atherosclerotic vascular pathology that is principally manifested as intermittent claudication because of peripheral vascular ischemia. Precise etiological factors are not yet concretely identified, and it represents 0.1 % of all lower limb claudication causes. Middle-aged males are the most affected gender age group. Misdiagnosis of Popliteal Artery ACD could delay proper management and hence risk the loss of the affected limb due to critical limb ischemia.

CASE PRESENTATION

We hereby explore the rare case of a 51-year-old female patient, who complained of vague left lower extremity pain accompanied by paresthesia for 1 month prior to admission without signs of local inflammation. The preoperative radiological assessment suggested the presence of thrombosis within the left Popliteal Artery which caused an occlusion in it and hence the proper blood flow was compromised.

CLINICAL DISCUSSION

Surgical intervention and the complete removal of the lesion along with establishing a patent synthetic anastomotic graft to maintain the preexisting vascular bundle was the key to treating our patient. Microscopic analysis of the excised specimen revealed an Adventitial Cystic Disease of the Popliteal Artery.

CONCLUSION

Adventitial Cystic Disease represents an extremely rare vascular pathology with a vast margin of non-specific symptoms that could lead to misdiagnoses. It is fundamental to establish suitable preoperative screening protocols for it and sustain adequate levels of clinical awareness so that we can timely diagnose and in turn, achieve proper therapeutic interventions to plummet the potential disastrous complications that could ensue.

Inadvertent Stenting and Percutaneous Aspiration for Treatment of Adventitial Cystic Disease in the Popliteal Artery: A Case Report

Adventitial cystic disease (ACD) is a rare, non-atherosclerotic disease that mainly affects the popliteal artery. Treatment is primarily surgical as endovascular approaches are affected by high recurrence rates. However, some studies have reported successful endovascular treatments of popliteal ACD cases. A 55-year-old female presented with right calf claudication. Computed tomography angiography revealed segmental occlusion of the right distal superficial femoral artery. Subsequently, a drug-eluting stent was successfully deployed. However, an unusual adventitial cystic lesion occluding the lumen that was characteristic of ACD was detected during a postoperative imaging review. It was aspirated using an ultrasound-guided percutaneous needle and drained using a pigtail catheter for 24 hours. Follow-up images after 39 months showed a patent artery with no recurrence of any cystic lesions, highlighting successful ACD treatment via stenting, ultrasound-guided aspiration, and cyst drainage. Stenting and cyst aspiration can be an alternative option for selected patients with ACD.

Cystic adventitial disease of the popliteal artery with unusual spontaneous regression: A case report with literature review

This report highlights the case of cystic adventitial disease of the left popliteal artery in a 45‐year‐old male patient. Imaging modalities confirmed the diagnosis and high resolution MRI found a cystic connection to the adjacent knee joint. The evolution was unusual with spontaneous regression of the symptoms.

Treatment failure after rotational atherectomy and balloon angioplasty in recurrent cystic adventitial disease of the popliteal artery: a case report

Cystic adventitial disease (CAD), which usually affects the popliteal artery, is a rare vascular condition in which fluid accumulates in the sub-adventitial layer, compressing the lumen. Historically, surgical treatment is preferred over endovascular or minimally invasive techniques, due to its lower recurrence rates. Here, the case of a 67-year-old male patient, in whom rotational atherectomy was performed for recurrent CAD following surgical cyst excision and patch angioplasty is reported. The patient’s symptoms recurred one day after the rotational atherectomy procedure and repeat computed tomography angiography showed recurrence of the disease. Due to gradual worsening of the condition during 8 months of follow-up, left distal femoral artery to popliteal artery (below-the-knee) bypass surgery was performed using an ipsilateral reversed great saphenous vein graft. Follow-up has continued for 2 years without complications or requirement of additional treatment. This novel case is the first report of atherectomy attempted for recurrent CAD that led to an early recurrence. Our experience emphasises that additional surgical approaches should be selected over endovascular procedures for treating recurrent CAD.

Adventitial Cystic Disease of the Popliteal Vein, a Rare Cause of Lower Limb Deep Vein Thrombosis

Introduction

Cystic adventitial disease (CAD) is characterised by the accumulation of gelatinous fluid within the adventitial layer of a blood vessel. Over 90% of CAD occurs in the arterial system. Venous CAD most commonly involves the iliofemoral rather than the popliteal segments.

Report

This is the report of a 49 year old female patient with a previous right leg deep vein thrombosis (DVT). She presented to a vascular outpatient appointment with recurrent right lower extremity swelling. Venous duplex ultrasound showed an ectatic and incompetent right popliteal vein. Computed tomography (CT) venography showed focal ectasia of the right popliteal vein resulting from an eccentric low density cyst with a diameter of 15 mm. Under general anaesthesia, the patient was placed in the prone position. A lazy S incision was performed in the right popliteal fossa. The popliteal vein had an eccentrically thickened lateral bulge. After heparinisation, a longitudinal venotomy, endophlebectomy, and en bloc cyst removal were performed sequentially. Popliteal patch venoplasty was performed subsequently using the ipsilateral small saphenous vein. After six months, the patient remains on rivaroxaban. A follow up venous duplex ultrasound showed vein reflux through a standard calibre popliteal vein without evidence of cyst recurrence.

Conclusion

Venous CAD is a rare disease and should be considered if previous DVT or symptoms mimicking DVT occur. Cyst resection and reconstruction with vein patch, venous or synthetic graft is the most commonly used strategy and has lower rates of cyst recurrence and need for re-operation.

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Venous cystic adventitial disease is rare.

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Adventitial vein cysts may cause oedema and vein thrombosis.

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Venous ultrasound is the first diagnostic test.

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Complete cyst wall excision is crucial to prevent recurrence.

Cystic Adventitial Disease of the (ilio) Femoral Artery with a Connection to the Hip Joint: Case Report and a Review of the Literature

Objective

Cystic adventitial disease (CAD) is an uncommon non-atherosclerotic peripheral vessel disease, most often seen in the popliteal artery. Only a small number of cases involving the (ilio) femoral artery have been reported. The case of a 48 year old female with CAD of the left femoral artery with a connection of the disease to the hip joint on pre-operative imaging confirmed during surgery is described. A literature review of CAD of the (ilio) femoral artery with patient demographic data, symptoms, management, presence of a joint connection, and long term outcomes was performed.

Methods

Multiple databases (Medline, CINAHL, EMBASE) were searched and each article was cross referenced to collect the literature on CAD of the (ilio) femoral artery. Case studies or series of CAD of the (ilio) femoral artery in English between 1995 and 2021 were included.

Results

Sixteen case reports with 17 patients were included; 71% were male. CAD was unilateral in all case reports, with 53% on the right side. Patients presented with vascular symptoms including claudication (88%), a palpable pulsating mass (18%), acute limb ischaemia (6%) or limb swelling (8%). Computed tomography angiography (CTA) (76%) and duplex ultrasonography (47%) were the most commonly used imaging modalities. The common femoral artery was the most affected site (88%). Reported treatments were cyst resection and autologous vein reconstruction (six, one recurrence), cyst resection and patch repair (five, one recurrence), cyst resection with synthetic graft reconstruction (three, no recurrence), cyst resection (two, one recurrence), and cyst incision and decompression (one, one recurrence). In 18% of the cases, a connection between the CAD and hip joint was seen.

Conclusion

Cyst resection and ligation with interposition of an autologous vein graft, synthetic graft or patch repair (in only locally affected arteries) seems to be the preferred treatment, with a low reported recurrence rate. CTA and magnetic resonance imaging are the imaging modalities of choice when suspecting CAD to determine an appropriate pre-operative plan and identify joint connections.

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CAD could be considered in relatively young patients with vascular symptoms.

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CTA and MRI should be the imaging modality of choice when suspecting CAD.

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Manage CAD with cyst resection and autologous/synthetic graft or patch interposition.

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Ligation of CAD is recommended to reduce the chance of recurrence.

Venous cystic adventitial disease: to cure or manage? A case series

Venous cystic adventitial disease is a rare vascular condition that can have significant effects on a patient's quality of life. The clinical presentation of venous cystic adventitial disease is variable, and there are no established guidelines on investigation or treatment of the disease. We present a series of three patients with venous cystic adventitial disease of the common femoral vein, treated within a single vascular surgery unit. Each of the three patients presented within 18 months of each other, despite the rarity of the disease. These are the only known cases treated within this vascular surgery unit. The investigation, management and treatment of each patient are individualised, with a management focus on quality of life.

Adventitial cystic disease of the common femoral vein: an unusual cause of lower extremity swelling and review of the literature

We report the case of a 61-year-old man who had presented with acute unilateral limb swelling. Computed tomography venography and duplex ultrasound demonstrated compression of the right common femoral vein by a common femoral vein adventitial cyst. Before intervention, the patient had developed an acute deep vein thrombosis of the right common femoral vein and great saphenous vein. Preoperative magnetic resonance imaging demonstrated concern for synovial connection. After 6 months of anticoagulation therapy, the patient underwent adventitial cyst excision with ligation of the hip joint articular connection. At 4 months postoperatively, the patient was symptom free without cyst recurrence. The findings from the present case support the synovial theory for adventitial cystic disease.

Nonatheromatous Popliteal Artery Disease

OBJECTIVE

Peripheral artery disease (PAD) is often caused by atherosclerosis. However, causes other than atherosclerosis is often overlooked. Popliteal artery entrapment syndrome (PAES) and popliteal artery adventitial cystic disease (PACD) are two common nonatheromatous causes of claudication and critical limb ischemia. The purpose of this study is to present early results of treatment of PAES and PACD involving the lower limbs.

METHODS

From December 2019 to February 2021, 10 patients with PAES underwent surgeries, and 1 patient with PAES received conservative treatment. 2 patients with PACD underwent surgery. Patient data including age, gender, etiology of vascular pathology, diseased vessel, surgical method, and hemodynamic status were collected retrospectively.

RESULTS

The mean follow-up duration was 5.64 ± 3.72 months (range, 1-12 months). All patients had their symptoms improved or resolved. The success rate of surgery was 100%, the rate of freedom from reintervention for any reason was 100%. There were no death, bleeding, embolism, or skin ulcers during late follow-up.

CONCLUSIONS

PAES and PACD require early diagnosis and intervention, and early surgery may lead to good early- and mid-term results.

A novel mechanism for the formation and propagation of neural tumors and lesions through neural highways

By recognizing anatomic and radiologic patterns of rare and often misdiagnosed peripheral nerve tumors/lesions, we have defined mechanisms for the propagation of neural diseases. The novel concept of the nervous system serving as a complex system of "highways" driving the neural and perineural spread of these lesions is described in three examples: Intraneural dissection of joint fluid in intraneural ganglion cysts, perineural spread of cancer cells, and dissemination of unknown concentrations of neurotrophic/inhibitory factors for growth in hamartomas/choristomas of nerve. Further mapping of these pathways to identify the natural history of diseases, the spectrum of disease evolution, the role of genetic mutations, and how these neural pathways interface with the lymphatic, vascular, and cerebrospinal systems may lead to advances in targeted treatments.

Adventitial Cystic Disease of the Superficial Femoral Vein without a Joint Connection: A Case Report

Adventitial cystic disease (ACD) of the veins is a rare vascular disease. Most cases of venous ACD are located adjacent to the joint area, such as the common femoral, external iliac, and popliteal veins. To the best of our knowledge, 67 cases of venous ACD have been reported, and ACD of the superficial femoral vein (SFV) has never been reported. Herein, we report the case of a 57-year-old male who presented with swelling and discomfort in the left leg. Computed tomography venography revealed multiple cystic lesions in the left distal SFV. The patient underwent cyst excision, which relieved the compression in the vein, although mild stenosis prevailed in the SFV. After a week, thrombosis developed in the popliteal vein. The thrombosis resolved after three months of anticoagulant therapy, and the patient showed no recurrence of ACD during three years of follow-up.

Long-term outcome of partial resection in venous adventitial cystic disease

Venous adventitial cystic disease is extremely rare. Therefore, standard treatment methods have not been clearly defined. Some reports suggest that complete cyst removal is an effective treatment. However, considering the relatively high recurrence rate, follow-up periods were short. Herein, we report the case of a 75-year-old man with venous adventitial cystic disease successfully treated with partial cyst wall excision. No recurrence was observed for 10 years postoperatively. This case suggests that complete cyst wall excision might not be necessary for the treatment of venous adventitial cystic disease.

Cystic adventitial disease of the popliteal vein and artery in siblings

Cystic adventitial disease (CAD) is an uncommon condition in which mucoid cysts form within the adventitial layer of the arterial or venous wall. We have presented two cases in which two first-degree relatives (brother and sister) had acquired CAD ∼6 years apart, one involving the popliteal artery and the other involving the popliteal vein. We have reported a rare case of a possible familial association of CAD. We have discussed the etiology, diagnostic criteria, and imaging modalities between arterial and venous CAD to aid in the management and selection of optimal treatment strategies.

Adventitial cystic disease in the external iliac artery of a 29-year-old man

Adventitial cystic disease (ACD) is an uncommon condition that generally occurs at the popliteal artery but, rarely, can occur in the external iliac artery. To date, only eight cases of ACD occurring in the external iliac artery have been reported. We have reported the case of a 29-year-old man who had presented with new-onset claudication. Despite an extensive imaging workup, ACD was not confirmed until the gross intraoperative examination. We have reported our process of diagnosis and treatment in addition to that reported in previous studies to enhance the historical fund of knowledge for this rare pathology.

Spontaneous Resolution of Cystic Adventitial Disease of the Popliteal Artery

Spontaneous resolution of cystic adventitial disease (CAD) is rare with occasional reports in the literature. In this case report, we are describing a 30-year-old man who presented with rapid onset of severe intermittent claudication and was diagnosed with CAD. Resection of the lesion with autologous vein replacement was scheduled. However, the claudication suddenly improved at 4 weeks after onset. Ultrasonography and computed tomography revealed regression of the cystic lesions with resolution of the popliteal artery stenosis. His symptoms did not recur during the 12-month follow-up period. Although it is unclear whether this resolution is permanent, in this report, we describe our experience with a case of CAD that eventually spontaneously regressed and the possibility of conservative treatment.

[Adventitial cyst of the popliteal artery]

Vascular cystic adventitious degeneration (CAD) is a rare disease of unclear etiology that affects mainly the popliteal artery (up to 85-90% of cases). Clinical manifestations are similar to aneurysm of the popliteal artery. CAD occurs mainly in males of the 4^th and 5^th decades of life (range 10-77 years). These patients usually have no risk factors of cardiovascular diseases. Unilateral symptoms prevail. We report a review and a 46-year-old patient with CAD of the popliteal artery.

Cystic Adventitial Disease Presenting as Occlusion of the External Iliac Artery: A Rare Manifestation

Cystic adventitial disease (CAD) is a rare, non-atherosclerotic cause of peripheral arterial disease characterized by mucinous cyst formation in the adventitial layer of arteries; with approximately 80% to 90% of cases involving the popliteal artery. We describe a case of CAD presenting in a female with left external iliac artery occlusion and intermittent claudication, for whom an intra-operative diagnosis of CAD of the ilio-femoral segment was made. A 37-year-old mother-of-two was referred to a Vascular Surgeon with a 3 to 4-year history of progressive intermittent claudication. A computed tomography (CT) angiogram demonstrated a left external iliac artery occlusion. Given the location of the lesion, the absence of cardiovascular risk factors and the patient's history of cycling, a diagnosis of left external iliac artery occlusion secondary to arterial endofibrosis or spontaneous arterial dissection was thought to be likely. A left Rutherford-Morrison incision was made and an extraperitoneal approach used to expose the left iliac system. A cyst was opened and marsupialized along the superior aspect of the external iliac artery, releasing gelatinous material. A provisional intra-operative diagnosis of CAD was made. The patient was systemically heparinized and an external iliac to common femoral artery bypass was performed using reversed ipsilateral greater saphenous vein. CAD primarily involves the popliteal artery. Under 40 cases of CAD with iliofemoral involvement have been reported. Our case is unusual given the location of CAD, as well as its occurrence in a female. Management options for similar cases have been described in the literature ranging from cyst excision and arterial patching, to interposition bypass and even exclusion bypass, in the case of longer segment occlusions. In our case, an exclusion bypass was deemed the most appropriate treatment given the extensive length and complete occlusion of the external iliac artery.

Effectiveness of Surgical Treatment with Complete Cyst Excision for Cystic Adventitial Disease of the Popliteal Artery

BACKGROUND

Cystic adventitial disease is a rare, nonatherosclerotic disease that affects various arteries and veins, involving the formation of a mucinous cyst within the adventitia. The etiology of the cystic adventitial disease is currently unclear, with several hypotheses having been suggested. The purpose of this retrospective observational study was to evaluate the etiology of popliteal cystic adventitial disease based on imaging and surgical findings and to evaluate the efficacy of surgical treatment.

METHODS

From April 2013 to January 2020, nine patients were diagnosed with the popliteal cystic adventitial disease and underwent surgical treatment. We performed complete resection of the cyst and the affected segment of the popliteal artery, followed by interposition with autologous reversed small saphenous vein or great saphenous vein.

RESULTS

The resected adventitial cyst tissue was multilobular, filled with high-viscosity mucus. Pathologic examination of the surgical specimen revealed intramural cysts filled with gelatinous material located between the media and the adventitia, consistent with the clinical diagnosis of cystic adventitial disease. The median follow-up period was 27.5 months (range: 2-91 months). All patients underwent cyst excision with graft interposition, and the overall graft patency was 80.9 months (95% CI: 62.2-99.6 months).

CONCLUSIONS

Computed tomography, magnetic resonance imaging, and surgical findings confirmed communication between the synovial cyst and arterial adventitia. It is recommended that priority be given to surgical resection and graft interposition because this can eliminate the disease's cause and reduce its recurrence.

An unexpected intraoperative finding of cystic adventitial degeneration of the common femoral artery

Herein we present a rare case of cystic adventitial degeneration involving the common femoral artery (CFA) of a 71-year-old patient, an unusual site of presentation of the disease. The most commonly affected district is the popliteal artery, and only a few cases of CFA involvement are described in literature. The history and comorbidities of the patient oriented us initially towards the diagnosis of an atherosclerotic obstructive disease. It was only intraoperatively indeed that a diagnosis of cystic adventitial arterial degeneration was made, subsequently confirmed by microscopic examination. Our case shows how both clinical and instrumental diagnosis of cystic adventitial disease can be challenging, given its non-specific presentation and low incidence. Suspicion of cystic adventitial degeneration is recommended in patients with sudden appearance of symptoms and with an isolated lesion of the affected artery without other involvement of the vascular tree.

Adventitial Cyst of the Popliteal Artery

Teaching Point: This clinical case shows the importance of also examining the arteries when investigating suspected deep venous thrombosis.

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

Adventitial cystic disease (ACD) is a very rare condition characterized by the accumulation of a cyst filled with gelatinous substance in the adventitia of a vessel adjacent to the joint area. The cyst usually compresses the vessel lumen, causing claudication or leg swelling. The disease usually affects the popliteal artery. However, several cases of venous ACDs particularly in the common femoral or external iliac vein have been reported. The definition, diagnosis, and optimal treatment of ACD remain controversial because of its rarity and the inconsistent use of terminology. The heterogeneity of the reported cases is more prominent in venous ACD. Herein, the accurate terminology of cysts correlated to the joint (synovial cyst, ganglion cyst, and adventitial cyst) and the pathogenesis, anatomy, and optimal therapy of venous ACD are discussed in detail to establish reporting standards for future studies.

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

Adventitial cystic disease of the venous system is an extremely rare condition. Forty-five cases have been described in the literature during the last 70 years, but they may not be representative of the real incidence of this pathologic process. We report a case of an adventitial cyst compressing the right external iliac vein and presenting with edema of the ipsilateral leg. Ultrasound imaging and computed tomography angiography showed the typical features of cystic disease and venous stenosis. Cyst excision was performed with a double surgical access. No perioperative complications were reported. There was no recurrence at 4-year follow-up.

Surgical Resection of an Adventitial Cyst of the Right Brachiocephalic Vein

Adventitial cystic disease is an uncommon vascular anomaly known to occur in peripheral vessels but mediastinal appearances are extremely rare. Herein, we report the case of an adventitial cyst occurring in the right brachiocephalic vein which might have been associated with ovarian hyperstimulation syndrome.

A case of cystic adventitial disease of the poplitealartery: selection of incision of the cyst wall overvessel replacement

Cystic adventitial disease (CAD), a rare arterial disorder, can cause localized arterial stenosis or obstruction. A 55-year-old man presented with a 2-month history of left lower leg pain and paleness when bending the left knee. The patient was diagnosed with CAD of the left popliteal artery based on imaging examinations. Surgery was performed with the patient placed in the prone position using an S-shaped skin incision, and the left popliteal artery was exposed. A simple incision of the cyst wall was made. There was no sign of recurrence at 1 year postoperatively.

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

Purpose

Adventitial 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 Methods

We 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.

Results

Recurrence 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%).

Conclusion

As a curative surgery for ACD, vessel excision with interposition grafting is a better strategy to prevent recurrence than simple cyst excision alone.

Cystic Arterial Disease Located Only in the Media of the Popliteal Artery: A Case Report

Adventitial cystic disease of the popliteal artery is a rare non-atheromatous peripheral artery disease. In most cases, the cystic lesion is located in the adventitia of the popliteal artery. Herein, we present a rare case of cystic arterial disease in which the cyst was located only in the media of the popliteal artery. We successfully treated the cyst with resection of the affected popliteal artery and reconstruction with an autogenous vein graft.

Treatment Options for Venous Cystic Adventitial Disease: A Case Report and Literature Review

Venous cystic adventitial disease (CAD) is an uncommon vascular anomaly that most frequently affects the common femoral vein. Transluminal or transadventitial evacuation followed by cyst excision is considered an effective treatment for this condition, although the recurrence rate is relatively high. Herein, we report a case of a 59-year-old man with venous CAD that was successfully treated with saphenous vein patch angioplasty after mucoid evacuation and cyst excision, and we discuss the options for treating venous CAD.

Cystic Adventitial Disease of the Common Femoral Vein Successfully Treated with Resection, Synthetic Graft Reconstruction, and Fistula Creation

Cystic adventitial disease (CAD) is a rare, benign disease of blood vessels which most commonly affects the popliteal artery. Less than 50 cases of CAD affecting veins have ever been described in the literature to date. We report the case of a 56-year-old woman who presented with unilateral lower extremity swelling and varicosities due to CAD of her common femoral vein. Resection and reconstruction with a venous interposition graft, employing a polytetrafluoroethylene graft and arteriovenous fistula in order to maintain venous bypass patency, were performed successfully. The patient recovered well without any evidence of recurrence or postoperative complications.

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

The cystic adventitial disease of the popliteal artery is an uncommon cause of intermittent claudication in young patients. Several treatment options are available, oriented to either drainage of the cyst and/or arterial reconstruction. Endovascular techniques have been exceptionally used to treat this condition, with mixed results. We report 2 young claudicants treated with primary stenting with continuous 4- and 10-year symptomatic relief and arterial patency.

Cystic adventitial disease of femoral vein presenting as enlarging lower limb swelling and pain: Two case reports and review of the literature

Cystic adventitial disease (CAD) is a condition that mainly affects the arterial system but rarely involves the venous system. The present study reported on two cases of CAD of femoral veins. The clinical manifestations in the two patients included pain and swelling of the lower limbs, but they had no risk factors for venous thrombosis. Color ultrasonography indicated cystic space-occupying lesions around the femoral veins, and enhanced computed tomography (CT) revealed vascular compression and space-occupying properties of the femoral veins. The two patients underwent open surgery, the postoperative treatment was uneventful, and swelling and tenderness were completely resolved. The pathological examination confirmed CAD of femoral vein in the two patients. The enhanced CT venography scan indicated patency of the femoral vein in the two patients following the operation. The circumferences of the two patients' lower limbs had returned to normal at the 2-month follow-up. A review of the literature was performed, and the presentation, diagnosis, treatment and pathology of this rare condition were discussed.

Spontaneous Regression of Cystic Adventitial Disease of the Popliteal Artery: A Case Report

Spontaneous regression of cystic adventitial disease (CAD) of the popliteal artery is rare. In this report, we describe a 53-year-old woman who presented with left calf pain and was diagnosed with CAD with popliteal artery stenosis, which regressed without therapy. The disease was diagnosed via computed tomography, and a surgical intervention was planned at the time of diagnosis. However, her symptoms disappeared 2 months after the initial presentation. Ultrasonography and computed tomography revealed spontaneous regression of the cystic lesions and resolution of the popliteal artery stenosis. During the 29-month follow-up period, her symptoms did not recur. Although CAD often requires surgical intervention, it may be acceptable to carefully observe patients with spontaneous regression for some time to check for recurrence.

Cystic Adventitial Disease of the Tibial Vein Arising From the Subtalar Joint: A Case Report

Soft tissue ganglion cysts are a well-known cause of tibial nerve compression in the tarsal tunnel. We describe a patient who presented with tibial nerve symptoms and was found to have an adventitial cyst of the tibial vein arising from the subtalar joint, with the joint connection confirmed both on imaging and at surgery. Surgical decompression of the cyst with transection of the vascular pedicle arising from the subtalar joint improved her symptoms at 6 months, and postoperative magnetic resonance imaging showed resolution of the cyst. Cystic adventitial disease is a rare, poorly understood condition in which a cyst is identified in the adventitia of a vessel, usually an artery. Only 3 cases of adventitial cysts have been reported in the foot and ankle region, 2 in the lesser and 1 in the greater saphenous vein. None of the previous cases have been recognized to be joint connected. This case provides additional evidence for an articular origin for adventitial cysts and helps guide management strategies for these joint-connected cysts.

Superficial radial intraneural ganglion cysts at the wrist

Superficial radial intraneural ganglion cysts are rare. Only nine previous cases have been described. We provide two examples with a wrist joint connection and review the literature to provide further support for the unifying articular (synovial) theory for the pathogenesis and treatment of intraneural ganglia.

CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY

Cystic adventitial disease (CAD) is a rare cause of unilateral intermittent claudication of unknown aetiology, which is characterized by the formation of multiple mucin-filled cysts in the adventitial layer of the arterial wall resulting in obstruction to blood flow. The disease predominantly presents in young otherwise healthy males and most commonly affects the popliteal artery (85% of cases). CAD can be diagnosed by duplex ultrasound, magnetic resonance imaging, magnetic resonance angiography, or computed tomographic angiography. Surgery is the primary mode of treatment, including exarterectomy, or replacement of the affected vascular segment by venous or synthetic interposition graft. Alternatively, the cysts can be drained by percutaneous ultrasound-guided needle aspiration. We conducted a review of the literature on the aetiology, diagnosis and treatment of this uncommon condition and present the case report.

Adventitial Cystic Disease of the Radial Artery

Upper extremity adventitial cystic disease is rare, but the characteristic findings of this lesion should be known to the hand surgeon and used to guide treatment. We present a case of a young adult male who developed a painless mass in his distal forearm. Diagnostic imaging workup revealed a cystic mass that extended within and encased the radial artery. Both MRI and direct intraoperative visualization confirmed the presence of a stalk connecting the intra-mural radial artery mass to the radiocarpal joint. The mass and stalk were excised en bloc with fenestration of the volar capsule to prevent recurrence. This case demonstrates a less common example of upper extremity adventitial cystic disease and supports the articular theory of origin of these lesions. When surgical excision is performed, an attempt should be made to identify and excise the articular stalk in an effort to minimize risk of recurrence.