Popliteal Artery Occlusion Secondary to Cystic Adventitial Disease: A Rare Etiology of Lower Extremity Ischemia in a Marathon Runner

Abstract

A 44-year-old marathon runner was referred with a 2-week history of the sudden onset of severe left calf claudication. Angiography showed a 3- to 4-centimeter focal nearocclusion of the left midpopliteal artery. Magnetic resonance imaging showed a cystic structure in the left popliteal artery wall. A left popliteal artery exploration revealed popliteal artery occlusion secondary to cystic adventitial disease. Excision of the cyst resulted in restoration of pedal pulses. This rare disease of uncertain etiology should be suspected in young adults presenting with ischemia. Various noninvasive techniques in conjunction with arteriography result in reliably diagnosing cystic adventitial disease. Excision of the cyst usually provides adequate treatment. Resection of the diseased arterial segment with autogenous bypass may be required.