Spontaneous rupture of an adventitial cyst of the popliteal artery: confirmation with MR imaging

Nonsurgical treatment of cystic adventitial disease of the popliteal artery caused by functional popliteal artery entrapment syndrome

Lower extremity claudication in young men can be caused by popliteal artery entrapment and vascular pathology. The case reported here describes a young male wrestler who presented with unilateral calf pain with activity. Imaging studies at rest demonstrated cystic adventitial disease of the popliteal artery. Stress imaging showed severe functional popliteal artery entrapment. This patient was treated with an imaging-guided botulinum toxin injection of the muscles at the site of arterial compression. The patient was asymptomatic 6 weeks after treatment. Repeat stress imaging demonstrated complete resolution of the entrapment and nearly complete resolution of the popliteal artery cystic adventitial disease.

Bilateral Adventitial Cystic Disease of the Popliteal Artery: A Case Report

Adventitial cystic disease (ACD) of the popliteal artery is an uncommon vascular condition of unknown etiology. In the present case report, we describe a case of bilateral ACD of the popliteal artery in a 58-year-old male. To the best of our knowledge, this is the first case of bilateral ACD of the popliteal artery reported in the literature.

Cystic Adventitial Disease: A Trap for the Unwary

Cystic adventitial disease is an uncommon condition. A case of cystic adventitial disease of the popliteal artery is reported in a young man who has been followed up for 14 years after surgical treatment. Early recognition and treatment of the condition will prevent progression to popliteal thrombosis and critical ischaemia. However, diagnosis of the condition is difficult. Characteristic features in the presenting history, such as fluctuation in severity of symptoms, sudden onset after vigorous activity and delayed recovery time after cessation of exercise are identified, which should help the clinician avoid misdiagnosis and delayed diagnosis of the condition. The clinician is also warned of the associated misleading clinical features such as the presence of normal peripheral pulses and normal ankle pressures in some cases of CAD.

Imaging characteristics of cystic adventitial disease of the peripheral arteries: presentation as soft-tissue masses

OBJECTIVE

Our purpose was to identify the characteristic imaging features of cystic adventitial disease of the peripheral arteries.

CONCLUSION

Patients with cystic adventitial disease of the peripheral arteries often present for evaluation of soft-tissue masses involving the extremities. Noninvasive imaging reveals a characteristic appearance allowing confident diagnosis.

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.