Adventitial cystic disease of the popliteal artery

Chronic Exertional Compartment Syndrome of the Foot

Active individuals can experience exercise-induced pain along the medial, plantar central, and plantarmedial proximal arch. In many cases, these symptoms are consistent with conditions involving the plantar fascia, posterior tibial tendon, or entrapment of branches of the posterior tibial nerve. Unlike these other conditions, chronic exertional compartment syndrome (CECS) of the foot can be aggravated by interventions that impart any pressure or compression to the foot. Practitioners should have a high index of suspicion for CECS when classic treatments tend to aggravate patient's symptoms.

Adventitial Cystic Disease of the Popliteal Artery: Successful Surgical Treatment of 8 Cases

Adventitial cystic disease is a rare condition with an unknown etiology predominently seen in young men. The clinical presentation is of a sudden onset of unilateral calf claudication with a progressive course.

Between May, 1988, and April, 1992, 8 patients have been operated on with the diagnosis of adventitial cystic disease of the popliteal artery in the authors' clinic. In 1 of the patients the lesion was bilaterally present in both of the popliteal arteries.

Early diagnosis and surgical treatment are of utmost importance to the success of treatment. The preferred treatment is arterial resection with venous bypass. This is highly effective and has good long-term results.

Adventitial cystic disease: a unifying hypothesis

PURPOSE

Six cases of adventitial cystic disease were studied, and the existing theories of the aetiology of adventitial cystic disease were reviewed to present evidence in support of a variation of the developmental hypothesis that might explain the sites of occurrence of this rare condition.

METHODS

Cases of adventitial cystic disease were collected by interrogation of the records of a group of vascular surgeons in the Johannesburg area. After reviewing the relevant literature, the sites of occurrence of 323 cases of adventitial cystic disease were documented, and the theories of the formation of adventitial cystic disease were reviewed. The embryological origin of those vessels in which adventitial cystic disease occurs was investigated. Clinical cases were collected in private practice vascular referral centers. The clinical features, treatment, and subsequent course of six cases of adventitial cystic disease (four related to the popliteal artery, one in the femoral artery, and one in the radial artery) are included.

RESULTS

All cases of adventitial cystic disease reported have occurred in the nonaxial arteries, which form at a later stage than the axial vessels during limb differentiation and development. It is therefore postulated that during limb bud development cell rests derived from condensations of mesenchymal tissue destined to form the knee, hip, wrist, or ankle joints are incorporated into the nearby and adjacent nonaxial vessels during development of these vessels in the 15-22-week stage. These newly forming nonaxial vessels develop from vascular plexuses during the same stage of development, and in close proximity to the adjacent condensing joint structures. It is further postulated that these cell rests are then responsible for the formation of adventitial cystic disease later in life, when the mucoid material secreted results in a mass lesion within the arterial or venous wall.

CONCLUSION

There is evidence supporting the hypothesis that adventitial cystic disease is a developmental condition occurring in the nonaxial blood vessels.

Cystic adventitial disease of the popliteal artery: diagnosis and treatment

PURPOSE

This paper represents the presentation of a case of cystic adventitial disease of the popliteal artery and an exhaustive review of the literature with an emphasis on optimal means for diagnosis and treatment of this unusual disease.

METHODS

We collect all reported cases of cystic adventitial disease of the popliteal artery since the last review in 1987 with an additional review of these cases reported in the U.S. since the initial description of the disease.

RESULTS

We found 264 cases of cystic adventitial disease (CAD) of the popliteal artery from 1954 to 1995, with 38 reported in the U.S. Fifty-eight new cases of CAD have been reported since the last review in 1987; 11 of these were reported in the U.S. Diagnosis of the disease has improved in the last few years with non-invasive techniques. Duplex color scanning followed by T2-weighted MRI now appears to be the best diagnostic choice. Various therapeutic methods have been described for the treatment of CAD. The recommended treatments are excision of the cyst with the cystic wall when the artery is stenotic and resection of the affected artery, followed by an interposition graft, when the artery is occluded.

CONCLUSION

Claudication in young, healthy patients resulting from popliteal artery stenosis or occlusion is a leading symptom of CAD. This disease affects males in a ratio of approximately 5:1 and appears predominantly in the fourth and fifth decades. The incidence is approximately 1 in 1200 cases of claudication or 1 in 1000 peripheral arteriograms. The predominance of reported cases is found in Japan and Europe. Optimal diagnostic techniques include duplex color scanning and T2-weighted MRI. The lesions can be effectively treated by resectional or non-resectional means depending on the presence or absence of complete arterial occlusion.

Critical ischaemia complicating cystic adventitial disease of the popliteal artery

Cases of cystic adventitial disease of the popliteal artery are presented to highlight the level of alertness necessary to recognise the characteristic clinical history of this uncommon condition before it progresses to critical limb ischemia when expeditious investigation and surgery are necessary to salvage the limb.