A multi-institutional experience in adventitial cystic disease.

Area of Science:

• Vascular Surgery
• Arterial Diseases
• Medical Databases

Background:

• Adventitial cystic disease (ACD) is an uncommon arteriopathy with limited literature on treatment.
• Existing knowledge is primarily based on case reports and small patient series.
• A multi-institutional database was utilized to investigate ACD presentation, management, and outcomes.

Purpose of the Study:

• To examine the clinical presentation of Adventitial Cystic Disease.
• To evaluate contemporary management strategies for ACD.
• To determine the long-term outcomes of ACD treatment using multi-institutional data.

Main Methods:

• A retrospective analysis of 47 patients diagnosed with ACD across 14 institutions over a 10-year period.
• Data collected included demographics, comorbidities, symptoms, imaging, treatment, and follow-up, adhering to Society for Vascular Surgery reporting standards.
• Univariate, multivariate, and life-table analyses were performed to compare treatments and identify factors associated with reintervention.

Main Results:

• The study identified 47 patients with ACD, predominantly affecting the popliteal artery (n=41). Lower extremity claudication was the most common symptom (93%).
• Preoperative diagnosis was achieved in 88% of cases, mainly via cross-sectional imaging.
• Surgical repair, including cyst excision with interposition or bypass grafts, showed a lower likelihood of reintervention (P=.04). Mean ankle-brachial index improved significantly postoperatively.

Conclusions:

• Adventitial cystic disease can often be diagnosed preoperatively using modern imaging techniques.
• Surgical intervention, specifically cyst excision combined with arterial reconstruction or bypass, provides effective long-term symptomatic relief.
• This approach minimizes the need for subsequent interventions to maintain arterial patency in ACD patients.