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Claudication due to adventitial cystic degeneration: A differential diagnosis of peripheral artery disease
1Vascular Surgery, Evangelisches Krankenhaus Bergisch Gladbach, Bergisch Gladbach, Germany.
Insights
Cystic adventitial disease (CAD) is a rare condition causing leg pain in young men. Surgical bypass offers the best long-term solution for this non-atherosclerotic arterial disease.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Rare Diseases
Background:
- Cystic adventitial disease (CAD) is a rare, non-atherosclerotic cause of arterial insufficiency.
- It primarily affects young, healthy men, presenting as intermittent claudication or critical limb ischemia.
- Approximately 300 cases have been reported since 1947, highlighting its rarity.
Observation:
- A case of cystic adventitial disease affecting the external iliac artery in a young policeman is presented.
- The patient exhibited symptoms of arterial insufficiency without typical cardiovascular risk factors.
- Diagnosis was confirmed via ultrasonography and conventional angiography.
Findings:
- Surgical intervention was the primary therapeutic approach.
- The procedure was successful, with no complications reported.
- The patient was discharged four days post-surgery.
Implications:
- CAD diagnosis should be considered in young patients with arterial insufficiency and no atherosclerosis risk factors.
- Catheter angiography is the preferred diagnostic tool when advanced imaging is unavailable.
- Reconstructive arterial bypass surgery appears to yield the best long-term outcomes for CAD.
Background:
Cystic adventitial disease (CAD) is an important and rare non-atherosclerotic cause of intermittent claudication and critical limb ischemia. Since the first case of CAD involving the external iliac artery was described by Atkins and Key in 1947, approximately 300 additional cases have been reported.
Objectives:
The aim of this article is to report a rare vascular disorder, predominantly seen in young healthy men with minimal cardiovascular risk factors.
Methods:
We report a rare case of cystic adventitial disease of a young policeman. To confirm the diagnosis, an ultrasonography and a conventional angiography were performed. The therapeutic approach was surgical first.
Results:
The procedure was successful without any complication, and the patient was discharged to home 4 days after procedure.
Conclusion:
While CAD is rare, the diagnosis should be suspected in a young patient who presents with arterial insufficiency and no risk factors for atherosclerosis. Catheter angiography is the investigation of choice in the absence of multislice CT and good MRA. It seems that the treatment that assures the best long-term results is reconstructive arterial bypass surgery.
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