Ballooning Angioplasty for Residual Stenosis after Cystotomy of the Popliteal Advential Cystic: A Case Report

Park, Seung Yun; Min, Seung Ki; Kim, Keon Kuk; Lee, Wun Ki; Lee, Jung Nam; Baek, Jung Hum; Oho, Jae Hwan; Chung, Min; Choi, Sang Tae

Abstract

Adventitial cystic disease (ACD) is an uncommon vascular disease of an unknown origin, and this malady can be suspected in a young, healthy patient who has sudden onset of claudication. We describe here a case of ACD of the right popliteal artery. A 43-year-old male presented with 4 month history of severe right leg claudication. He had no other atherosclerotic predisposing history except for 10 pack years of smoking. On examination, the right femoral pulses were normal, the popliteal artery absent and the dorsalis pedis and posterior tibial artey pulses were decreased. The ankle-brachial pressure index (ABI) was 0.4. Ultrasonography showed a hypoechoic cystic lesion with a well-defined marin along the arterial wall. Computed tomography showed a round hypodense cystic mass with thin enhancing rim and a non-enhancing center in the popliteal fossa. Operatively, the 2.5 cm-sized expanding cyst indented the popliteal artery, which involved half of its diameter with adhesion to the adhesion to the adjacent structures. The artery had no thrombosis and it was a short-segment lesion with luminal patency, but half of the arterial wall was thickened with inflammation. Partial excision of the cyst wall and evacuation of the gelatineous materials was performed. Postoperatively, his symptoms improved somewhat, but ABI was 0.6. On the angiography, there was residual stenosis and contrast pooling. These findings disappeared after balloon angioplasty. he was asymptomatic 6 months later with an ABI >1 in the right side.