Volume 48, Issue 3 September 2024 JVU 483-165 | Duplex Study of Right Popliteal Artery Revealed Adventitial Cystic Disease Followed by Surgical Repair-Volume 48, Issue 3 September 2024 JVU 483-165 | Duplex Study of Right Popliteal Artery Revealed Adventitial Cystic Disease Followed by Surgical Repair

Volume 48, Issue 3 September 2024 JVU 483-165 | Duplex Study of Right Popliteal Artery Revealed Adventitial Cystic Disease Followed by Surgical Repair

Back to course

Pdf Summary

This case report, published in the Journal for Vascular Ultrasound, documents a rare incidence of cystic adventitial disease (ACD) in the right popliteal artery of a 35-year-old female patient. ACD is characterized by the presence of a cyst within the adventitial layer of an artery, leading to vessel lumen stenosis or occlusion. The patient experienced worsening pain and muscle fatigue in her right calf, prompting medical evaluation.<br /><br />The initial diagnostic procedure involved a Parks FloLab lower extremity non-imaging physiologic test followed by a duplex ultrasound, which revealed the cystic adventitial disease. The ultrasound showed a focal narrowing caused by an anechoic lesion and confirmed the presence of a cystic structure within the artery. Prior to the ultrasound, a CT angiogram indicated significant narrowing of the artery, suggesting a possible dissection.<br /><br />Surgical intervention involved excising the affected arterial segment and performing an interposition graft using the contralateral great saphenous vein. Multiple mucinous and gelatinous cysts were found and removed during the procedure. Post-surgery, normal Doppler flow signals were observed, indicating successful blood flow restoration.<br /><br />The discussion highlights that ACD is frequently misdiagnosed or diagnosed late due to its rarity. The origin of the cysts remains unclear, with theories suggesting they may be mucin-producing cells from a nearby joint or directly linked to the synovium. Imaging techniques like ultrasound, CT angiography, and MRI play a crucial role in accurately diagnosing ACD by visualizing cystic masses and arterial compression. The study confirms that duplex ultrasound is the preferred modality due to its non-invasive nature and high resolution.<br /><br />The conclusion reaffirms the effectiveness of imaging in diagnosing ACD and underscores the importance of considering this condition in patients with exertional leg pain. The preferred treatment involves surgical removal of the cyst and replacement of the affected artery segment with a graft to ensure long-term relief and artery functionality.

Keywords

cystic adventitial disease

popliteal artery

vascular ultrasound

duplex ultrasound

CT angiogram

interposition graft

mucinous cysts

arterial stenosis

exertional leg pain

diagnostic imaging