Adventitial Cystic Disease of the Common Femoral Vein: Report of a Case / 日本心臓血管外科学会雑誌

A 68-year-old man suffered a pain in his right groin and was diagnosed with deep vein thrombosis at a previous medical clinic, two months earlier. He was referred to our hospital to treat deep vein thrombosis. However, adventitial cystic disease of the femoral vein was suspected from findings of preoperative contrast CT and ultrasonography. Under general anesthesia, the operation was performed. The venous wall was resected including an adventitial cyst, which was followed by the venous reconstruction using an autologous vein patch. Anticoagulant therapy was continued after the operation for one year. He was followed for 18 months after the surgery without a recurrence of the adventitial cystic disease. Venous adventitial cystic disease is extremely rare and may be misdiagnosed as deep vein thrombosis. Careful follow-up is mandatory, because the postoperative recurrence rate is reported to be substantially high.

Adventitial Cystic Disease of the Common Femoral Artery: A Case Report and Literature Review

Arterial adventitial cystic disease is an uncommon type of non-atherosclerotic peripheral vessel disease. Most cases of arterial adventitial cystic disease occur in the popliteal arteries; however, fewer cases have been reported in the femoral arteries. A 59-year-old male patient visited the hospital with a complaint of a swelling on the lower extremity that had begun two months earlier. Suspecting deep vein thrombosis based on a physical examination and ultrasonography from another hospital, tests were performed. Magnetic resonance imaging (MRI) was performed for exact diagnosis because venous adventitial cystic disease was suspected by computed tomography venography. The MRI indicated venous adventitial cystic disease as well. Thus, a cystic mass excision was performed. In the end, a cystic mass compressing the common femoral vein that originated from the common femoral artery was diagnosed based on the macroscopic findings. This case is reported because blood circulation in the vein was impeded due to arterial adventitial cystic disease, and the symptoms improved after the cystic mass excision and polytetrafluoroethylene roofing angioplasty.

Adventitial Cystic Disease of the External Iliac Vein in a Patient Presenting with Leg Edema

A 69-year-old male patient presented with a 2 week history of left leg swelling. The past medical history was unremarkable. On physical examination, his left leg was swollen up to the thigh and Homan's sign was positive. Duplex ultrasound revealed a solid and cystic lesion localized only at the iliac vein. Surgical exploration was performed under the suspicion of adventitial cystic disease (ACD). The final pathologic diagnosis was ACD. Although ACD has usually been reported in arterial segments, venous involvement has been reported. In the majority of these reported patients, the common femoral vein is associated with venous ACD. According to a Medline search, there have been nine reports related with venous ACD. Only two cases of external iliac vein (EIV) involvement of ACD have been previously reported, including one Korean report. We report here on a case of recently experienced EIV ACD.

Ballooning Angioplasty for Residual Stenosis after Cystotomy of the Popliteal Advential Cystic: A Case Report

Adventitial cystic disease (ACD) is an uncommon vascular disease of an unknown origin, and this malady can be suspected in a young, healthy patient who has sudden onset of claudication. We describe here a case of ACD of the right popliteal artery. A 43-year-old male presented with 4 month history of severe right leg claudication. He had no other atherosclerotic predisposing history except for 10 pack years of smoking. On examination, the right femoral pulses were normal, the popliteal artery absent and the dorsalis pedis and posterior tibial artey pulses were decreased. The ankle-brachial pressure index (ABI) was 0.4. Ultrasonography showed a hypoechoic cystic lesion with a well-defined marin along the arterial wall. Computed tomography showed a round hypodense cystic mass with thin enhancing rim and a non-enhancing center in the popliteal fossa. Operatively, the 2.5 cm-sized expanding cyst indented the popliteal artery, which involved half of its diameter with adhesion to the adhesion to the adjacent structures. The artery had no thrombosis and it was a short-segment lesion with luminal patency, but half of the arterial wall was thickened with inflammation. Partial excision of the cyst wall and evacuation of the gelatineous materials was performed. Postoperatively, his symptoms improved somewhat, but ABI was 0.6. On the angiography, there was residual stenosis and contrast pooling. These findings disappeared after balloon angioplasty. he was asymptomatic 6 months later with an ABI >1 in the right side.

Ballooning Angioplasty for Residual Stenosis after Cystotomy of the Popliteal Advential Cystic: A Case Report

Adventitial cystic disease (ACD) is an uncommon vascular disease of an unknown origin, and this malady can be suspected in a young, healthy patient who has sudden onset of claudication. We describe here a case of ACD of the right popliteal artery. A 43-year-old male presented with 4 month history of severe right leg claudication. He had no other atherosclerotic predisposing history except for 10 pack years of smoking. On examination, the right femoral pulses were normal, the popliteal artery absent and the dorsalis pedis and posterior tibial artey pulses were decreased. The ankle-brachial pressure index (ABI) was 0.4. Ultrasonography showed a hypoechoic cystic lesion with a well-defined marin along the arterial wall. Computed tomography showed a round hypodense cystic mass with thin enhancing rim and a non-enhancing center in the popliteal fossa. Operatively, the 2.5 cm-sized expanding cyst indented the popliteal artery, which involved half of its diameter with adhesion to the adhesion to the adjacent structures. The artery had no thrombosis and it was a short-segment lesion with luminal patency, but half of the arterial wall was thickened with inflammation. Partial excision of the cyst wall and evacuation of the gelatineous materials was performed. Postoperatively, his symptoms improved somewhat, but ABI was 0.6. On the angiography, there was residual stenosis and contrast pooling. These findings disappeared after balloon angioplasty. he was asymptomatic 6 months later with an ABI >1 in the right side.

Adventitial Cystic Disease of Popliteal Artery

Adventitial cystic disease of popliteal artery is a rare cause of lower extremity claudication in the middle aged. We diagnosed an adventitial cystic disease using duplex sonography and spiral CT angiography and operated on a 58 year old man with progressive lower extremity claudication for 4 months. An operation was performed by removing all cystic lesions through the posterior approach of popliteal fossa and interposition graft 6mm PTFE. Preoperative claudication symptom was disappeared and postoperative CT angiography showed patent graft at 17 months after operation

Isolated Popliteal Artery Disease

PURPOSE: An isolated popliteal artery lesion is relatively rare, with different clinical characteristics to those of atherosclerosis. There are several diseases found at the artery around the knee joint. The cases of knee joint artery experienced by the author studied, and the clinical characteristics evaluated. METHOD: Between 2001 and 2005, 8 patients underwent surgical treatment for isolated popliteal disease at our hospital. Of these 5 cases were for popliteal entrapment syndrome, one case for popliteal adventitial cystic disease, and 2 cases for an isolated popliteal artery aneurysm. The two cases of popliteal entrapment syndrome had bilateral involvement; therefore, a total of 10 legs were treated surgically. We analysed the clinical characteristics and surgical results from the patients' medical records. RESULT: The popliteal entrapment syndrome patients were younger than those with the other diseases. The main symptom of popliteal entrapment syndrome and adventitial cystic disease was calf claudication, which occurred insidiously after physical abuse, but the symptom of the popliteal artery aneurysm was due to acute venous congestion or arterial occlusion. Most of the cases were diagnosed with a CT angiogram. One gastrocnemius myomectomy and 6 popliteal interposition bypasses using the autogenous saphenous vein, were performed in the cases of popliteal entrapment syndrome. An arterial reconstruction, with an open cystectomy, was performed in the case of the adventitial cystic disease. Popliteal interposition bypass, with isolation of the popliteal aneurysm, was performed in the popliteal aneurysm. During the mean follow up period of 10.8+/-10 months, the arterial flows to the involved feet were patent in all cases. CONCLUSION: Isolated popliteal artery disease is not usually suspected but easy to diagnose with recently developed imaging study. If diagnosed properly and treated timely, the result of the surgical treatment of isolated popliteal artery disease can be excellent.

Adventitial Cystic Disease of the Popliteal Artery: A case report

Adventitial cystic disease of the popliteal artery is a rare disorder that causes localized stenosis or occlusion by compression of the vessel lumen. The disease produces lower extremity claudication, typically in young and middle-aged men. We report a case of the adventitial cystic disease of the popliteal artery in a 55-year-old man with symptom of left calf claudication. Diagnosis was done by ultrasound, angiography, and magnetic resonance imaging. The patient was treated with resection of the diseased popliteal artery followed by interposition of saphenous vein graft. Postoperatively, the symptom and sign resolved completely.

Popliteal Arterial Disease

PURPOSE: The popliteal artery is the site of uncommon conditions such as popliteal artery entrapment syndrome (PAES), adventitial cystic disease (ACD) and aneurysmal disease. Because of their rarity, these nonatheromatous conditions are often not diagnosed until they reach an advanced stage. We conducted this retrospective study to analyse the clinical characteristics of popliteal arterial disease and to establish a proper diagnostic and therapeutic strategy. METHODS: Among the 31 patients who underwent an operation for popliteal arterial disease between Jan. 1986 and Dec. 1998 in SNUH, 14 patients with isolated popliteal arterial disease were included in this study, excluding 17 patients with combining significant arterial disease in other area. The symptoms, risk factors for vascular disease, laboratory findings, radiologic findings and the patency rate after operation were analyzed. RESULTS: The mean age of the patients were 38 years (12~64) and male-to-female ratio was 13:1. There were 6 cases of PAES, 2 cases of popliteal aneurysms, ACD and thromboangiitis obliterans respectively, and 1 case of atherosclerosis obliterans and embolism each. Arteriography was performed in all cases and duplex sonogram (5 cases), CT (2), CT angiography (3), and MR angiography (2) was performed additionally. For treatment of the arterial occlusion, bypass or interposition graft was done in all cases. Along with the arterial reconstruction, division of medial head of gastrocnemius muscle was done in 4 cases of PAES, excision in 1 case of ACD, and aneurysmectomy in 1 case of popliteal aneurysm. Patency rates of the graft after 1 and 3 years were 92% and 80.9% respectively. There was no limb or patient loss. CONCLUSION: Isolated occlusive disease of popliteal artery is mostly nonatheromatous condition such as PAES or ACD. Therefore those diseases should be suspected in young patient with leg ischemia without other risk factor for systemic vascular disease. Duplex ultrasound and CTA or MRA are accurate diagnostic tools to differentiate the lesions and make the proper therapeutic plan.