Cystic adventitial disease of the popliteal artery

Although rare, popliteal artery cystic adventitial disease (CAD) is one of the most common non-atheromatous causes of intermittent claudication. This work aims to describe the clinical case of a 50 years old male patient with symptomatic popliteal artery CAD, presenting with calf intermittent claudication for long distances on flat but 50m in ascending plane, which affected his life quality. On examination he presented with normal coloration and temperature of the lower extremities, with distal pulses present at rest. By flexing the right knee, he lost distal pulses. On ultrasound was found a cystic formation surrounding the right popliteal artery, so a MRI was done and confirmed the presence of an adventitial cystic surrounding about 50% of the artery at the popliteal fossa with 31x13x17mm. He underwent surgery with a posterior approach followed by cyst removal, preservating the media of the artery, and ligation of a ductus that seemed to extent from the articular capsule. At the fourth post-operative day he was discharged and remained without symptoms nor recurrence during the follow up. The CAD usually affects the popliteal artery (85%). It's more common in men with 35-40 years and the prevalence is estimated at 1/1200 claudicants. The symptoms are caused, usually, by extrinsic compression of the artery. Ultrasound, today, is the first line exam, and might be complemented with others to confirm the diagnosis and plan the treatment. The surgical treatment may vary from drainage to segmental arterial resection in case of significant degeneration. The prognostic is usually favorable.