We report the case of a 26-year-old male with CAD of the right popliteal artery diagnosed non-invasively with 3 Tesla cardiovascular magnetic resonance and confirmed on post-operative histopathology. 9. Ultrasound Q 2015;31:224-6. The diagnosis of cystic adventitial disease was confirmed by surgery. 10. Cystic adventitial disease is an uncommon vascular disorder characterized by cystic degeneration of a peripheral artery. The condition usually affects the popliteal artery, which supplies blood to the knee joint and calf muscles and foot. The disease is most likely to occur in young and middle-aged men. Cystic adventitial disease (CAD) is a rare vascular disorder. Therefore, a diagnosis of cystic adventitial disease was confirmed A). A 4-cm segment of the popliteal artery was found to be involved in the cystic process, which increased the external diameter of the vessel to about 1 cm. Ksepka M, Li A, Norman S. Cystic Adventitial Disease. Introduction. Recently, IVUS is currently the standard of reference for imaging vessel wall morphology. Received for publication October 15, 2014; accepted February 23, 2015. Cystic Adventitial Disease Ultrasound Q. CAD can rarely recur after treatment. Levien LJ, Benn CA. Cystic adventitial disease of popliteal artery is a rare condition of unknown etiology which usually presents in middle-aged men. Cystic adventitial disease should be suspected in middle-aged female patients who present with sudden-onset intermittent claudication of lower limb without the presence of atherosclerotic disease. Ypsilantis EA, Tisi PV. Cystic adventitial disease (CAD) of the popliteal artery with spontaneous regression is rare. Intraoperative Duplex Scanning of Adventitial Cystic Disease 539 range from ultrasound-graded aspiration, per- encountered. We present Doppler and computed tomography angiography findings in a case of cystic adventitial disease with significant obstruction of popliteal artery, with secondary narrowing of popliteal vein. 2010;4:91. Cystic degeneration of the adventitia of the popliteal artery. The etiology of CAD is unclear; however, the direct communication between a cyst and a joint is presumed to be a cause. Surg Today 2000;30:1026–1029. Cases of cystic adventitial disease of the popliteal artery are presented to highlight the level of alertness necessary to recognise the characteristi… Journal of medical case reports. Angiography, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used for diagnosis. We therefore recommend intraoperative cutaneous angioplasty (both with high incidence of duplex for this procedure. Cystic adventitial disease has been described as consisting of a collection of clear gelatinous material within an aberrant synovial type cyst located in the subadventitial plane of the wall of a major artery. The findings obtained from Magnetic Resonance Imaging were non-diagnostic. Sem Hop 1967;43:3005-13. Cardiovascular Ultrasound. 1 Since then, more than 350 cases have been reported. Ultrasound, MRI, and CT revealed CAD of popliteal artery with simple cystic lesion and are valuable in diagnosing and deciding the strategy of operation. figure 4 Cystic adventitial disease of the posterior vein wall as seen through an anterior venotomy (A) with gelatinous mucin extruding from the cyst (white arrow). Treatment of CAD can be done via surgical resection or percutaneous intervention such as aspiration. Cystic adventitial disease of the popliteal artery. The lesion was excised, and a venous bypass graft was inserted. Until recently, ACD of the popliteal artery was diagnosed predominantly by angiography. Ksepka, Martha MD *; Li, Albert MD †; Norman, Sorkin MD † Author Information . Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2014. Apropos of a further case. (1) Since then, more than 350 cases have been reported. Am Surg 1985;51:455-9. Intravascular ultrasound imaging reliably identifies cystic adventitial disease; its application can be recommended as an alternative to established diagnostic procedures (computed tomography, magnetic resonance imaging) in patients … CAD was diagnosed, and resection of the lesion with autologous vein replacement was scheduled. Cystic lesion within the right common femoral vein (circles) projects into the vessel lumen, which is narrowed but preserved. 2015 Sep;31(3):224-6. doi: 10.1097/RUQ.0000000000000160. testing in diagnosing a popliteal artery adventitial cyst. However, the simpler operative … - Adventitial cystic disease is an unusual cause of lower-extremity ischemia. Cystic adventitial disease (CAD) is a rare cause of intermittent claudication and nonatherosclerotic conditions in middle-aged men without cardiovascular risk factors. Any peripheral artery can be affected; however, the disorder has a striking proclivity for the popliteal artery and typically affects young to middle-aged men without evidence of atherosclerosis or other systemic vascular disease []. The first case was of a 49-year-old man, treated by excision of the involved arterial segment and interposition of an autologous saphenous vein graft. We describe a 44-year-old man with rapid onset of severe intermittent claudication who is currently undergoing conservative follow-up. Linquette M, Mesmacque R, Beghin B, et al. Image‐directed Doppler ultrasound findings in adventitial cystic disease of the popliteal artery Stapff, Manfred; Zoller, Wolfram G.; Spengel, Florentin A. Differential diagnoses: Thrombosed aneurysm, Baker’s cyst, ganglion cyst or peri-meniscal cyst. However, the claudication suddenly improved at 5 weeks after onset. Zoller, MD, and Florentin A. Spengel, MD Adventitial cystic disease is an uncommon cause of arterial stenosis or occlusion, and was first described by Atkins.' - A 60-year-old man with venous insufficiency and prior deep vein thrombosis was referred for a lower-extremity venous evaluation. Adventitial cystic disease is a rare disease that occurs when a cyst filled with a mucus-like substance forms in one of the arteries, most commonly in the popliteal artery, which supplies blood to the knee joint and thigh and calf muscles. The diagnosis resulted from Echo-Doppler ultrasonography along with peak exercise … Atkins and Key first described its effect on the external iliac artery in 1947. PURPOSE: To evaluate percutaneous ultrasound (US)-guided aspiration as an alternative therapy for adventitial cystic disease. MR imaging and ultrasonography imaging now are used more frequently because they are less invasive and provide more information than angiography. The authors declare no conflict of interest. Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disorder in which a mucin-containing cyst develops in the adventitial layer of the artery. Koppensteiner R(1), Katzenschlager R, Ahmadi A, Staudacher M, Horvat R, Polterauer P, Ehringer H. Author information: (1)Department of Medical Angiology, University of Vienna, Austria. Involvement of the genicular branches in cystic adventitial disease of the popliteal artery as a possible marker of unfavorable early clinical outcome: a case report. DISCUSSION. recurrence), to operative bypass and patch angioplasty. Cystic adventitial disease (CAD) of the popliteal artery is a rare cause of lower extremity claudication. An ultrasound scan shows a small remanant of the previous cyst posterior to the popliteal artery measuring 8 mm. Ultrasound finding of cystic adventitial disease of the popliteal artery—A rare diagnosis for claudication Cystic Adventitial Disease. Symptoms of Adventitial Cystic Disease. It affects large arteries, typically where the artery is near a joint space, and the popliteal artery is most commonly involved. 1989-11-01 00:00:00 Manfred Stapff, MD, Wolfram G . Cystic adventitial disease of the popliteal artery: elongation into the media of the popliteal artery and communication with the knee joint capsule—report of a case. Cystic adventitial disease often affects individuals in the fourth and fifth decade of life; however, it has been reported in individuals ranging from 10 to 77 years of age. Popliteal arterial adventitial cystic disease is a rare disor-der causing intermittent claudication that is well described in young adults, and was first reported by Atkins and Key [1] in a 40-year-old man. The diagnosis of cystic adventitial disease made by intravascular ultrasound imaging was confirmed by sur- gery. We therefore recommend intraoperative cutaneous angioplasty (both with high incidence of duplex for this procedure. Adventitial cystic disease is a rare condition in which a cyst forms in an artery and narrows or blocks blood flow. Stallworth JM, Brown AG, Burges GE, et al. Most patients are males in their 40s or 50s who present with intermittent claudi-cation of sudden onset and rapid progression. Paul Dimuzio We report two such cases, each of which was treated differently. Cystic adventitial disease. The subsequent extrinsic compression of the arterial lumen leads to peripheral vascular insufficiency and intermittent claudication. Crossref, Medline, Google Scholar; 20 Fox CJ, Rasmussen TE, O Donnell SD. Methods. Cystic Adventitial Disease. Venous cystic adventitial disease of the common femoral vein. The cyst can narrow or block the affected artery. Authors Martha Ksepka 1 , Albert Li, Sorkin Norman. We describe popliteal arterial adventitial cystic disease which causes intermittent claudication in a young athletic man, with atypical manifestation, without loss of foot pulses on knee flexion nor murmur in the popliteal fossa. Keywords: Cystic adventitial disease (CAD); computed tomography angiography (CTA); ultrasound (US); Duplex ultrasound examination and computed tomography scans performed 3 months after the onset of symptoms revealed a multilocular cystic formation within the right popliteal artery wall, determining a severe luminal stenosis. Atkins and Key first described its effect on the external iliac artery in 1947. Note the normal left common femoral vein (c). recurrence), to operative bypass and patch angioplasty. Cystic adventitial disease is a rare vascular disease which can involve the popliteal, external iliac, femoral, radial, and ulnar arteries . MATERIALS AND METHODS: Between September 1993 and June 1996, seven patients (six men, one woman; age range, 42-62 years; mean age, 48 years) presented with symptomatic adventitial cystic disease of the popliteal artery (one patient with subacute foot … 2009;7:23. Cystic adventitial disease of the popliteal artery. In rare cases, the condition can cause cysts to form in other arteries. Demonstration of cystic adventitial disease by intravascular ultrasound imaging. Cystic adventitial disease (CAD) of the popliteal artery is a rare vascular disease of unknown etiology in which a mucin-containing cyst develops in the adventitial layer of the artery. Cystic adventitial disease (CAD) is a rare vascular disorder. Multiple intramural cystic masses were seen to be compressing the arterial lumen. Eur J Vasc Endovasc Surg Vol 16, December ]998 Intraoperative Duplex Scanning of Adventitial Cystic Disease 539 range from ultrasound-graded aspiration, per- encountered. 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