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Cystic adventitial pathology as an entity in peripheral arterial disease
Anne Lejay1, Mickaël Ohana, Charline Delay
1Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France - anne-catherine.lejay@orange.fr.
Insights
Cystic adventitial disease (CAD) is a rare arterial condition. This review updates diagnosis and treatment, highlighting cyst resection and joint connection management to reduce recurrence.
Area of Science:
- Vascular Surgery
- Radiology
- Medical Diagnostics
Background:
- Cystic adventitial disease (CAD) is a rare condition involving mucinous cysts in artery and vein adventitia.
- Current management strategies for CAD are not well-defined, with varied imaging and treatment approaches documented.
- This study aims to provide an updated overview of CAD in arterial territories, covering etiology, diagnosis, imaging, and treatment.
Purpose of the Study:
- To update the understanding of cystic adventitial disease (CAD) in arterial territories.
- To review current knowledge on CAD etiology, clinical diagnosis, imaging modalities, and treatment options.
- To provide a comprehensive resource for clinicians managing patients with CAD.
Main Methods:
- A systematic review of case reports and case series concerning CAD.
- Searches conducted across Medline, Embase, and Cochrane databases.
- Inclusion of studies reporting on arterial CAD, its diagnosis, and management.
Main Results:
- Identified 513 reports detailing 677 arterial cysts.
- Utilized various imaging modalities including Duplex ultrasonography, MRI, CTA, and conventional angiography.
- Cyst resection with saphenous vein graft reconstruction was the most common treatment (259 cases); recurrence occurred in 51 patients.
- Ligation or resection of identified joint connections (40 cases) prevented recurrence.
Conclusions:
- Cystic adventitial disease (CAD) should be considered in the differential diagnosis of peripheral arterial disease, especially in middle-aged men without atherosclerosis.
- Further understanding of CAD pathogenesis is needed to establish consensus treatment strategies.
- Effective management, including addressing joint connections, can improve outcomes and reduce recurrence rates.
Background:
Cystic adventitial disease (CAD) is a rare condition in which mucinous cyst forms within the adventitia of arteries and veins. The management of CAD still remains unclear and a wide range of imaging and treatment options has been described. The purpose of this study is to propose an update of etiology, clinical diagnosis, imaging modalities and treatment options in the setting of CAD described on arterial territory.
Methods:
We performed a systematic review including studies reporting case or case series of CAD, searching across the Medline, Embase and Cochrane databases.
Results:
We identified 513 reports and 677 arterial cysts. Various imaging modalities such as Duplex ultrasonography, magnetic resonance imaging, computed tomographic angiography and conventional angiography were included. A wide range of treatment options have been performed with the most common being cyst resection followed by saphenous vein graft reconstruction in 259 cases. Follow-up was described in 431 cases with an average of 33 months. There were 51 patients who developed cyst recurrence. Among the 102 cases where joint connection was identified, 40 had either ligation of the joint connection or joint resection, which led to no recurrences.
Conclusions:
CAD must be considered as en entity in peripheral arterial disease and considered in the differential diagnosis, in particular for middle-aged male patients who show no evidence of atherosclerotic disease. A better understanding of the pathogenesis of CAD will allow a consensus on treatment strategy and improve outcomes by reducing recurrence rates.
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