Cystic adventitial disease of the popliteal artery

A 57-year-old male presented with a 1-month history of progressive left calf intermittent claudication after walking a distance of 30 meters. He had no risk factors for cardiovascular disease. Clinical examination revealed diminished popliteal and pedal pulses on the affected limb. Doppler sonography demonstrated an ovoid cystic formation (Panel A, arrow) compressing the left popliteal artery and causing severe narrowing of the lumen (blue color). The blood flow velocity of the popliteal artery was 198 cm/s. Computed tomographic angiography with three-dimensional reconstruction of the left popliteal artery showed a cystic lesion with homogeneous attenuation intensity (24 HU) (Panel B, arrow) within the wall of the popliteal artery smoothly compressing the adjacent arterial lumen. A posterior approach to the popliteal fossa was performed and revealed a cystic lesion of 2.5 cm in length (Panel C, arrow) in the wall of the popliteal artery, filled with viscous, mucous fluid. The cyst was punctured and after evacuating the gelatinous fluid, the wall was carefully resected. Histopathology of the surgical specimen confirmed the diagnosis of cystic adventitial disease. The patient recovered uneventfully and remained asymptomatic during the 12-month follow-up period. Adventitial cystic disease is characterized by the development of cystic spaces with mucoid content in the adventitia, which is responsible for localized stenosis or occlusion of the artery lumen. The disease predominantly affects the popliteal arteries (about 85% of cases) and more rarely the common femoral, external iliac, radial and ulnar arteries and veins.1