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Arteropathies, Microcirculation and Vasculitis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Adventitial cystic disease is a very rare condition characterized by the accumulation of a cyst-like space filled with gelatinous substance in the adventitia of the popliteal artery. The cyst usually compresses the vessel lumen, causing claudication. Several cases of venous adventitial cystic disease, particularly in the common femoral or external iliac vein, have been reported. The heterogeneity of terminology applied to this entity (synovial cyst, ganglion cyst and adventitial cyst) has led to considerable confusion. A cyst is a closed sac with a distinct cellular lining. A pseudocyst is a cyst-like structure that lacks epithelial or endothelial cell linings. A synovial cyst is a juxta-articular fluid-filled collection lined by synovial cells and may communicate with the joint via a stalk. Ganglion cyst is caused by a defect in the joint capsule or tendon sheath which allows the joint fluid to leak from the joint space and become surrounded by fibrous connective tissues and is thus a pseudocyst. Adventitial cystic disease is a variant of ganglionic cyst in which the cyst extends along the vessel wall adventitia. Due to the strong fibroelastic nature of the adventitia, the cyst extends proximally or distally along the vessel until it grows large enough to compress the lumen in a concentric or eccentric manner. Because the cyst extends in the confined area of the adventitia, it can easily compress the vessel lumen even when it is small. The extension can be cranial, caudal, transverse or spiral along the vessel axis, which makes complete cyst excision extremely difficult. Because the cyst and the vessel share the adventitia, it is immensely challenging to remove the cyst completely without causing vessel tear and aneurysmal dilation of the vessel wall. Venous adventitial cyst also occurs and complete removal of the cyst wall compressing the vein is extremely difficult and commonly results in vein tearing or venous aneurysmal change after cyst resection. This usually leads to vessel replacement with a patch or an interposition graft. The joint connection should be eliminated to prevent recurrence.8
Adventitial cystic disease of the popliteal artery
Published in Baylor University Medical Center Proceedings, 2019
Rachel Rendon, Kristyn Mannoia, William Shutze
Adventitial cystic disease (ACD) is a rare vascular disorder characterized by fluid accumulation in the adventitial layer of a vessel, which may cause luminal narrowing or even complete occlusion.1,2 The cystic fluid has been described as gelatinous or mucoid in consistency, with a high content of hyaluronic acid and different combinations of mucopolysaccharides and mucoproteins.1,3 Symptoms of ACD depend on the location of the cyst, with the popliteal artery being the most common vessel affected.3 When the popliteal artery is affected, the most common presenting symptom is intermittent claudication that is usually acute in onset and of longer duration than claudication associated with atherosclerosis.1–3 We present two cases of cystic adventitial disease of the popliteal artery.