Cystic adventitial disease van de arteria poplitea: casus en literatuuroverzicht

Abstract

Cystic adventitial disease of the arteria poplitea: case report and literature review Cystic adventitial disease (CAD) is a relatively rare condition (responsible for 1 in 1,200 cases of calf claudication) with the formation of a mucinous cyst in the tunica adventitia. The arterial, rather than the venous, vascular structures are affected in a relatively young, predominantly male population. Several locations have been described, most of them in the popliteal artery (80-85%). Etiologically, several hypotheses have been put forward, without clear consensus, although the synovial and developmental theories are currently considered the most plausible. The patient’s history generally involves complaints of claudication without the presence of important cardiovascular risk factors. Typically, a spasmodic feeling in the calf with varying degrees of exertion is described, with spontaneous recovery after some period of rest. Of paramount importance is the consideration of CAD in a story of intermittent claudication. A Doppler ultrasound, as well as a CT scan and/or an MRI with associated angiography can all be used for the diagnosis. Surgery with complete excision and interposition of a venous graft is the treatment of choice. The cyst can also be drained by means of a percutaneous ultrasound-assisted needle aspiration, but this is associated with a high need of revision. Percutaneous endovascular treatment with a balloon angioplasty (and possibly stenting) does not show favorable results. Recurrence of CAD after surgical resection is minimal. Recently, several cases have been described with spontaneous resolution of claudication after conservative management without surgical resection need and/or aspiration.