Cystic Adventitial Disease of the Popliteal Artery

Abstract

Cystic adventitial disease of the arteries is a rare and only recently recognized entity which most commonly occurs in the popliteal artery, causing intermittent claudication. Three further cases affecting the popliteal artery are presented. The aetiology of the condition is obscure. The cyst containing gel may be unilocular or multilocular, and appears to arise from the arterial adventitia. Histology shows no evidence of haemorrhage, inflammation, or neoplasia. The absence of hydroxyproline in the gel is against an origin from collagen or elastin, and its occurrence in children is against degenerative changes in the arterial wall. The typical clinical picture is of intermittent claudication of sudden onset in a young adult male. The pulse pattern is variable and the popliteal pulse may be absent or more easily palpable than normal, or an audible bruit may be present over it. Exercise or knee flexion may cause the disappearance of pedal pulses. The arteriographic appearance is of stenosis, displacement, or occlusion at or above the level of the knee joint in an otherwise normal popliteal artery. A review of the results of treatment indicates that after complete excision of the cyst (with or without arteriotomy) or arterial resection with autogenous vein-graft replacement the prognosis is excellent. © 1967, British Medical Journal Publishing Group. All rights reserved.