Adventitial Cystic Disease of the Popliteal Artery with Nocturnal Rest Pain

TL;DR

A rare case of popliteal artery cystic disease with nocturnal rest pain was successfully treated with surgery and showed long-term improvement.

Contribution

This paper presents a unique case of ACD with nocturnal rest pain not previously documented in the literature.

Findings

The patient's ACD was successfully treated with arterial segment excision and vein grafting.

Nocturnal rest pain was resolved post-surgery with normal limb function at 17-year follow-up.

Literature review found no prior reports of ACD with similar nocturnal rest pain symptoms.

Abstract

Arterial cystic disease (ACD) affecting the popliteal artery (PA) is a rare form of non-atherosclerotic vascular disease. This cystic tumor is defined by the accumulation of a mucinous substance in the adventitia. Treatment options include percutaneous cyst aspiration, percutaneous transluminal balloon angioplasty, the evacuation of the cyst through a surgical approach, and resection of the affected artery segment followed by arterial reconstruction using autologous venous or prosthetic grafting. Our hospital received a 36-year-old man who had an intermittent claudication and periodically nocturnal rest pain in the left lower limb. Duplex scanning and CTA showed an entrapment of the left PA by a structure related to the arterial wall with an approximate 80% stenosis. The pedal and posterior tibial pulses faded when the knee was flexed. The ACD of the PA was diagnosed. An excision of an affected arterial segment and revascularization of the PA with great saphenous vein procedures were performed. We were unable to locate any instances in the literature of ACD accompanied by nocturnal rest pain that resembled the case we have presented. At a seventeen-year follow-up, the patient’s condition was reported as normal with no intermittent claudication or rest pain in the left lower limb.

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