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Long-Segment Adventitial Cystic Disease of the Popliteal Artery Requiring Adductor Hiatus Division: A Case Report
1Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
Insights
Adventitial cystic disease (ACD) of the popliteal artery, a rare condition causing calf pain, can involve long segments. Surgical division of the adductor hiatus enabled successful resection and grafting for a 10 cm ACD lesion.
Area of Science:
- Vascular Surgery
- Vascular Imaging
- Rare Diseases
Background:
- Adventitial cystic disease (ACD) of the popliteal artery is a rare vascular condition.
- It typically presents as a focal lesion causing intermittent claudication.
- Long-segment involvement of the popliteal artery by ACD is exceptionally uncommon.
Purpose of the Study:
- To describe a case of long-segment adventitial cystic disease (ACD) of the popliteal artery.
- To highlight the surgical approach for managing extensive ACD.
- To emphasize preoperative assessment and surgical planning for ACD.
Main Methods:
- A 53-year-old man with progressive calf claudication underwent imaging (CT, MRI, ultrasound).
- Intraoperative findings revealed a 10 cm cystic lesion extending into the adductor hiatus.
- A posterior surgical approach with adductor hiatus division, resection of the cystic segment, and great saphenous vein interposition grafting was performed.
Main Results:
- Imaging underestimated the true extent of the adventitial cystic disease (ACD).
- Adductor hiatus division was necessary for proximal control of the long-segment ACD.
- The patient experienced complete symptom resolution following surgical intervention.
Conclusions:
- A posterior surgical approach with adductor hiatus division is feasible for long-segment adventitial cystic disease (ACD) of the popliteal artery.
- Thorough preoperative assessment is crucial for accurate diagnosis and surgical planning in ACD.
- Tailored surgical strategies are essential for successful management of extensive ACD.
Abstract:
BackgroundAdventitial cystic disease (ACD) of the popliteal artery is a rare cause of intermittent claudication, typically presenting as a focal lesion, with long-segment involvement being even more uncommon.Case SummaryA 53-year-old man presented with progressive left calf claudication for one year, worsening over the last 6 months. Imaging studies, including computed tomography and magnetic resonance imaging, identified a cystic lesion compressing the popliteal artery, with duplex ultrasound estimating its length at 6 cm. However, intraoperative findings revealed the lesion extended over 10 cm into the adductor hiatus. To achieve proximal control, adductor hiatus division was required. The cystic segment was resected, and a great saphenous vein interposition graft was placed. The patient recovered uneventfully with complete symptom resolution.ConclusionThis case highlights the feasibility of a posterior approach with adductor hiatus division for long-segment ACD, emphasizing the importance of thorough preoperative assessment and tailored surgical planning.
