What is adventitial cystic disease?
Adventitial cystic disease is a rare condition in which a cyst forms in an artery and narrows or blocks blood flow. The condition usually affects the popliteal artery, which supplies blood to the knee joint and calf muscles and foot. In rare cases, the condition can cause cysts to form in other arteries.
What are the symptoms of adventitial cystic disease?
The symptoms of adventitial cystic disease are leg pain or heaviness brought on by walking or exercising. The pain typically goes away with stopping the walking or exercise but it often slow to resolve (up to 20 minutes). The duration of symptoms is generally relatively short (weeks to months). The leg pain is known as intermittent claudication (walking pain). Some patients also have pain behind the knee.
The symptoms of adventitial cystic disease are similar to popliteal artery entrapment (PAES). If a young patient has pain when walking, the doctor will check for both of these conditions.
Who is at risk of developing adventitial cystic disease?
Young to middle-aged males are the most likely to develop adventitial cystic disease. The cause of the problem is still unknown. Men are affected five times more commonly than women.
How is adventitial cystic disease diagnosed?
If you have symptoms of adventitial cystic disease, a vascular specialist can help make the diagnosis. You will have a physical exam that includes checking the pulse in your foot and popliteal artery. If you have the condition, the doctor may be able to feel the pulses while you’re resting, but they may be harder to detect when you exercise or bend your knee.
You will have imaging tests to detect a cyst. These may include:
- Ankle brachial pressures with exercise – Measures the blood pressures in the arms and legs before and after exercise
- Duplex Ultrasound – Uses sound waves to image the artery and measure blood flow
- Computed tomographic angiography (CTA) – Type of CT scan that uses dye to look for areas around the knee with poor blood flow or narrowed arteries
- Magnetic Resonance Angiography (MRA) – Test using magnetic field and pulses of radio wave energy to provide pictures of muscles tendons and blood vessels inside the body
What type of treatment is available for patients with adventitial cystic disease?
Your treatment for adventitial cystic disease is based on your symptoms and test results.
If you are having symptoms, your doctor will likely recommend surgery. A vascular surgeon removes the cyst and reconstructs the section of the blood vessel, if necessary. If you have surgery, it is unlikely that the cyst will return. Aspiration of the cyst has been used in rare cases but the risk is of recurrence is higher if the cyst is aspirated.
What can I expect after having adventitial cystic disease surgery?
Hospital stay is typically one to two days. Physical therapy may be done as an outpatient to help facilitate recovery by using stretching and flexibility exercises.
What type of follow-up care will I need?
Follow up ultrasound of the repaired artery and blood pressure checks in the feet will be done in the office at one to two months in the office and at one year. If the artery has returned to normal you won’t need any further follow-up visits unless your symptoms return.
How do I find a doctor who treats patients with this condition?
The Miller Family Heart & Vascular Institute Resource & Information Nurse can provide a referral to a Cleveland Clinic vascular specialist familiar with this condition. Contact us or call 216.445.9288 or toll-free at 800.289.6911. We would be happy to assist you.
- Sharath C. V. Paravastu, John M. Regi, Douglas R. Turner and Peter A. Gaines. A contemporary Review of Cystic Adventitial Disease, Vascular and Endovascular Surgery 2012;(46) 5-14. Accessed July 7, 2014.
- Paritosh Sharma, P, Padhiar, N, Kyriakides, C. Popliteal Cystic Adventitial Disease Causing Intermittent Claudication in a Young Athlete: A Case Report. South Med J. 2008;101(11):1154-1156. Accessed July 7, 2014.
- Perlowski AA, Jaff MR, Vascular Disorders in Athletes, Vascular Medicine. 2010;16(6):469-479. Accessed 5/22/2014.
- Cronenwett J.L. MD, Johnston, W. Rutherford’s Vascular Surgery, 7th ed. 2005. Nonatheromatous popliteal artery disease, Chapter 111. Saunders Elsevier.