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Niizeki T, Ishino M, Kitahara T, Yamauchi S, Ikeno E, Kubota I. A Case of Cystic Adventitial Degeneration of the Left Popliteal Artery Diagnosed by Intravascular Ultrasound. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:11-4. [PMID: 26949345 PMCID: PMC4772905 DOI: 10.4137/ccrep.s38175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 11/17/2022]
Abstract
An 87-year-old male was admitted with intermittent claudication of the left calf. We performed lower extremity angiography, which revealed stenosis of the left popliteal artery. Intravascular ultrasound (IVUS) image correctly identified the cystic appearance of visualized extravascular hypodensity, causing extrinsic compression of the lumen. We diagnosed the condition as cystic adventitial degeneration (CAD) of the popliteal artery. We operated a resection of a cyst with the artery and replaced the autovein graft (saphenous vein). After surgery, the patient was free of symptoms. CAD is a rare disease; thus, our IVUS findings may provide unique diagnostic clues in patients with CAD.
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Affiliation(s)
- Takeshi Niizeki
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Mitsunori Ishino
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Tatsuro Kitahara
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - So Yamauchi
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Eiichiro Ikeno
- Department of Cardiology, Okitama Public General Hospital, Yamagata, Japan
| | - Isao Kubota
- First Department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan
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Del Canto Peruyera P, Vázquez MJVV, Velasco MB, Álvarez PC, Salgado AÁ, Álvarez JC, Fernández LJÁ. Cystic adventitial disease of the popliteal artery: Two case reports and a review of the literature. Vascular 2014; 23:204-10. [PMID: 24986869 DOI: 10.1177/1708538114541652] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two cases of cystic adventitial disease treated at our institution over the last year are presented. They were middle-aged and apparently healthy patients, and the symptoms begin with a sudden onset of unilateral claudication. After performing a magnetic resonance angiography, a cystic formation attached to the adventitia of the popliteal artery was identified. Both patients were treated in the same manner, with resection of the affected arterial segment and vein bypass interposition. Both remain asymptomatic after one year of follow-up in one case and six months in the other. Cystic adventitial disease is a rare entity, which presents in patients without cardiovascular risk factors, so sometimes it takes long to reach a definitive diagnosis. Concerning the different treatment options, cyst excision together with the affected arterial segment seems to offer better mid- and long-term results when compared with other treatment options such as cyst aspiration or endovascular techniques, although there are no multicenter trials evidencing the superiority of one against the others.
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Affiliation(s)
- P Del Canto Peruyera
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | | | - M Botas Velasco
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - P Calvín Álvarez
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - A Álvarez Salgado
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - J Cerviño Álvarez
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
| | - L J Álvarez Fernández
- Department of Angiology, Vascular and Endovascular Surgery, Cabueñes Hospital, Gijón, Spain
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3
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Desy NM, Spinner RJ. The etiology and management of cystic adventitial disease. J Vasc Surg 2014; 60:235-45, 245.e1-11. [DOI: 10.1016/j.jvs.2014.04.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/06/2014] [Indexed: 12/20/2022]
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Hernández Mateo MM, Serrano Hernando FJ, Martínez López I, González Sánchez S, Hernando Rydings M, Saiz Jerez A, Revuelta Suero S, Marqués de Marino P. Cystic Adventitial Degeneration of the Popliteal Artery: Report on 3 Cases and Review of the Literature. Ann Vasc Surg 2014; 28:1062-9. [DOI: 10.1016/j.avsg.2013.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 09/09/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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Hao H, Ishibashi-Ueda H, Nishida N, Kawakami R, Tsukamoto Y, Tsujimoto M, Hirota S. Distribution of myofibroblast and tenascin-C in cystic adventitial disease: Comparison with ganglion. Pathol Int 2014; 63:591-8. [DOI: 10.1111/pin.12119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/14/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Hiroyuki Hao
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Naoki Nishida
- Department of Pathology; National Cerebral and Cardiovascular Center; Suita Osaka Japan
| | - Rika Kawakami
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | - Yoshitane Tsukamoto
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
| | | | - Seiichi Hirota
- Department of Surgical Pathology; Hyogo College of Medicine; Nishinomiya Hyogo Japan
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Chen Y, Sun R, Shao J, Li Y, Liu C. A contemporary review of venous adventitial cystic disease and three case reports. Phlebology 2013; 30:11-6. [PMID: 24357449 DOI: 10.1177/0268355513516948] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Venous adventitial cystic disease is a rare vascular disease. The objective of the study is to contemporarily review the literature of venous adventitial cystic disease and report three other new cases of adventitial cystic disease in common femoral vein. Articles published between 1947 and April 2013 were searched in OVID and PubMed databases. The search yielded only 38 reported cases of venous adventitial cystic disease. The general characteristics and disease management information of the 41 cases (including our current 3 cases) were analyzed. Venous adventitial cystic disease could develop late in life with an average age of 48.39 years (range, 5 to 77 years). Similar to arterial adventitial cystic disease, venous adventitial cystic disease was also found to have a male predominance (male to female ratio, 1.28:1). The common femoral vein was the most likely vein to be involved (65.9%, 27 cases). Right and left sides were almost equally affected. Extremity swelling (86.8%, 33 cases) was the main symptom of patients presenting with venous adventitial cystic disease. Excision of cyst wall in 30 patients (73.2%) was the main surgical procedure with a recurrence rate of 11.5%. Thirteen involved veins were resected; of which, 10 were reconstructed with prosthetic or autologous graft. No recurrence was reported in these 13 patients. Postoperatively, nine cases received an anticoagulation therapy. In conclusion, the etiology, treatment strategy, and outcomes of venous adventitial cystic disease could not be well understood in the present review due to limited numbers of cases. Studies with careful follow-up for at least up to first several months are recommended.
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Affiliation(s)
- YueXin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - RuiXue Sun
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - YongJun Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - ChangWei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Spinner RJ, Desy NM, Agarwal G, Pawlina W, Kalra M, Amrami KK. Evidence to support that adventitial cysts, analogous to intraneural ganglion cysts, are also joint-connected. Clin Anat 2012; 26:267-81. [DOI: 10.1002/ca.22152] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 07/26/2012] [Indexed: 11/09/2022]
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Spontaneous Resolution of Cystic Adventitial Disease: A Word of Caution. Ann Vasc Surg 2012; 26:422.e1-4. [DOI: 10.1016/j.avsg.2011.05.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 05/08/2011] [Accepted: 05/25/2011] [Indexed: 11/24/2022]
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Paravastu SCV, Regi JM, Turner DR, Gaines PA. A Contemporary Review of Cystic Adventitial Disease. Vasc Endovascular Surg 2011; 46:5-14. [DOI: 10.1177/1538574411419377] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cystic adventitial disease (CAD) is a rare vascular disorder, predominantly seen in young healthy men with minimal cardiovascular risk factors. Cystic adventitial disease can affect both arteries and veins. Patients with arterial CAD present with sudden onset or rapidly progressing claudication symptoms, and those with venous CAD present with limb swelling or very rarely deep vein thrombosis. Diagnosis is confirmed with the aid of imaging techniques such as ultrasonography, computed tomography, or magnetic resonance scan. Surgical resection or evacuation of the lesion is usually the preferred approach, with only mixed results reported for percutaneous endovascular techniques.
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Affiliation(s)
- Sharath C. V. Paravastu
- Academic Vascular Unit, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - John M. Regi
- Department of Vascular Interventional Radiology, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Douglas R. Turner
- Department of Vascular Interventional Radiology, Northern General Hospital, Sheffield, South Yorkshire, UK
| | - Peter A. Gaines
- Department of Vascular Interventional Radiology, Northern General Hospital, Sheffield, South Yorkshire, UK
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Drac P, Köcher M, Utikal P, Cerna M, Kozak J, Bachleda P. CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY: REPORT ON THREE CASES AND REVIEW OF THE LITERATURE. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2011; 155:309-21. [DOI: 10.5507/bp.2011.065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sakamoto A, Tanaka K, Matsuda S, Harimaya K, Nakamura T, Oda Y, Tsuneyoshi M, Iwamoto Y. Adventitial Cystic Disease of the Popliteal Vein: Report of a Case. Surg Today 2006; 36:1098-100. [PMID: 17123139 DOI: 10.1007/s00595-006-3296-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 05/09/2006] [Indexed: 11/30/2022]
Abstract
Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease seen mainly in arteries. It is very unusual for these cystic masses to develop in a vein. We report the case of a 56-year-old woman with leg swelling caused by ACD arising in the popliteal vein. The swelling appeared after a long period of standing. Magnetic resonance imaging (MRI) showed a popliteal cystic mass and venography showed disrupted venous flow. We resected the cyst wall without venous reconstruction, after which venous blood flow normalized and her symptoms subsided. To our knowledge, this is only the third documented case of ACD arising in the popliteal vein. A misdiagnosis could easily have been made, since the mass was not obvious on physical examination and the only symptom was intermittent swelling. Thus, it is important to be aware of ACD as a possible diagnosis when examining patients with a swelling in the leg.
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Affiliation(s)
- Akio Sakamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Abstract
Adventitial cystic disease (ACD) is an unusual cystic tumor of blood vessels characterized by the accumulation of mucinous substance in the adventitia of the non-axial blood vessels adjacent to joints. Patients with ACD often suffer from intermittent claudication and/or limb pain, mostly involving the popliteal artery. We report a 30-year-old male who presented with intermittent claudication in his left leg. Angiography showed an obstructive lesion in the left popliteal artery. The lesion was treated successfully by surgical excision followed by graft vessel replacement. ACD involving the popliteal artery was diagnosed by pathologic findings of multiple cysts of the adventitia with external compression and focal narrowing of the vascular lumen. The cysts contained acid mucin and were partially lined by multiple rows of cytologically bland, synovium-like cells with positive immunoreactivity to vimentin and CD68 but negative immunoreactivity to cytokeratin. The histopathologic findings in this case suggest that it was caused by the developmental rests of mucin-secreting mesenchymal cells derived from the knee joint.
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Affiliation(s)
- Chii-Hong Lee
- Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
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13
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Degeneración quística de la adventicia de la arteria poplítea. RADIOLOGIA 2004. [DOI: 10.1016/s0033-8338(04)77970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Foster MT, Collins JT, Morgan JP. Intravascular ultrasound diagnosis of cystic adventitial degeneration of the popliteal artery: a case report. Catheter Cardiovasc Interv 2001; 53:527-9. [PMID: 11515007 DOI: 10.1002/ccd.1216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The diagnosis of cystic adventitial degeneration (CAD) is difficult. We present the first case in which intravascular ultrasound (IVUS) correctly identified CAD of the popliteal artery when duplex sonography and angiography were inconclusive.
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Affiliation(s)
- M T Foster
- Department of Cardiology, Borgess Medical Center, Kalamazoo, Michigan, USA.
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Abstract
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.
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Affiliation(s)
- L J Levien
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Madhavan P, Boyle T, Coyle J, Cox M, McEniff N, Molloy M, Feeley TM. Cystic adventitial disease. Eur J Vasc Endovasc Surg 1998; 15:456-8. [PMID: 9633505 DOI: 10.1016/s1078-5884(98)80211-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- P Madhavan
- Department of Surgery, Meath/Adelaide Hospitals, Dublin, Ireland
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