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CASE REPORTS  VASCULAR SECTION


The Journal of Cardiovascular Surgery 2003 Aprile;44(2):255-8

lingua: Inglese

Cystic adventitial disease of the popliteal artery. Report of 1 case and review of the literature

Rispoli P. 1,2, Moniaci D. 1,2, Zan S. 1,2, Cassatella R. 1,2, Varetto G. 1,2, Maselli M. 1,2, Apostolou D. 1,2, Raso A. M. 1,2, Conforti M. 1,2

1 Unit of Vas­cular Sur­gery, Depart­ment of Sur­gical Sci­ences, Uni­ver­sity of ­Turin, ­Turin, ­Italy
2 Post­grad­uate ­School of Vas­cular Sur­gery, Uni­ver­sity of ­Turin, Molinette Hospital, ­Turin, ­Italy


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Cystic adven­ti­tial dis­ease (CAD) of the pop­li­teal ­artery is a ­rare but ­well-­known ­cause of inter­mit­tent claud­i­ca­tion, espe­cially in ­young ­patients. The eti­ology of the dis­ease is ­still con­tro­ver­sial and the lit­er­a­ture ­reports var­ious hypoth­eses for its ­origin. Diag­nosis ­starts ­with ­thorough his­tory ­taking and phys­ical exam­ina­tion; non inva­sive diag­nostic ­studies com­prise ­color ­duplex ­scanner (ECD), com­puted tomog­raphy (CT), ­better if eli­coidal (3D CT) and mag­netic res­o­nance ­imaging (MRI), ­which can aid in estab­lishing cor­rect rec­og­ni­tion of the dis­ease in ­most ­cases. A 48-year-old man pre­sented ­with inter­mit­tent ­right ­calf claud­i­ca­tion ­that had ­begun 4 months ear­lier; the ­symptom-­free ­interval was ­about 100 ­m. MRI and MR angio­graphy of ­right pop­li­teal ­fossa ­revealed the pres­ence of an ­oval ­cystic (max­imum diam­eter 45 mm). The ­caudal ­aspect of the ­cyst ­showed ped­i­cles pro­truding ­between the pop­li­teal ­vein and the pop­li­teal ­artery ­that com­pressed the ­artery, ­causing com­plete occlu­sion of its ­lumen. Sur­gery was per­formed ­through the pos­te­rior ­approach ­using an S-­shaped inci­sion; the ­affected seg­ment of the pop­li­teal ­artery was suc­cess­fully ­excised and ­replaced ­with an autog­e­nous ­external saph­e­nous ­vein ­graft. A ­follow-up is ­underway, ­both clin­ical and ­with; no ­cyst recur­rence has so far ­been ­detected ­either clin­i­cally or by ­duplex ­scanner ­during the 15-month ­postoper­a­tive ­follow-up ­period; the ­graft is ­patent and the ­patient is com­pletely ­symptom ­free. ­Severe claud­i­ca­tion in ­young ­patients, pos­sibly ­without sig­nif­i­cant vas­cular ­risk fac­tors, ­should ­prompt the clin­ical sus­pi­cion of adven­ti­tial ­cystic dis­ease of the pop­li­teal ­artery. Med­ical his­tory, clin­ical exam­ina­tion and non inva­sive instru­mental inves­ti­ga­tions, ­such as ­duplex ­scanner, eli­coidal CT and/or MRI, may aid in estab­lishing the cor­rect diag­nosis.

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