Cystic adventitial disease of the popliteal artery: report of two cases and review of the literature

Abstract

Cystic adventitial disease (CAD) is a rare vascular disease that causes a localized stenosis or occlusion in absence of alterations of blood vessels in other sites of the body. CAD is predominantly located to the popliteal artery, although cases have been described involving other arteries. Typically it affects young men with minimal cardiovascular risk factors, presenting a short history of progressive claudication. Imaging is based on US, CTA and MRA. Suspected diagnosis is confirmed at the time of the surgery. We report two cases of CAD involving the popliteal artery. In the first case a 59 year-old man was treated by resection of the popliteal artery and a reversed saphenous vein was used to restore circulation. In the second case a 53 year-old man was treated by resection of the popliteal artery and a cryo-preserved arterial graft was used to restore circulation. We also made a review of the literature on this subject.

Fig. 1

A - Case 1: Hourglass appearance at level of the popliteal artery by DSA. B - Case 1: Near-occlusive stenosis of the popliteal artery by axial CTA imaging. C - Case 1: Near-occlusive stenosis of the popliteal artery by sagittal CTA reconstruction. D - Case 1: Near-occlusive stenosis of the popliteal artery by 3D-CTA reconstruction. E - Case 2: Colordoppler-US showing on the anterior wall of the popliteal artery a large anechoic cyst. F - Case 2: Near-occlusive stenosis of the popliteal artery by axial CTA imaging. G - Case 2: Near-occlusive stenosis of the popliteal artery by 3D-CTA reconstruction.

Fig. 2

A - Case 2: Exposure of the affected popliteal artery B - Case 2: Complete replacement of the affected artery and reconstruction with tube-homograft and reimplantation of the anterior tibial artery.