Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Ann Vasc Surg. 2021 Apr;72:261-269. doi: 10.1016/j.avsg.2020.09.015. Epub 2020 Sep 16.
Cystic adventitial disease is a rare, nonatherosclerotic disease that affects various arteries and veins, involving the formation of a mucinous cyst within the adventitia. The etiology of the cystic adventitial disease is currently unclear, with several hypotheses having been suggested. The purpose of this retrospective observational study was to evaluate the etiology of popliteal cystic adventitial disease based on imaging and surgical findings and to evaluate the efficacy of surgical treatment.
From April 2013 to January 2020, nine patients were diagnosed with the popliteal cystic adventitial disease and underwent surgical treatment. We performed complete resection of the cyst and the affected segment of the popliteal artery, followed by interposition with autologous reversed small saphenous vein or great saphenous vein.
The resected adventitial cyst tissue was multilobular, filled with high-viscosity mucus. Pathologic examination of the surgical specimen revealed intramural cysts filled with gelatinous material located between the media and the adventitia, consistent with the clinical diagnosis of cystic adventitial disease. The median follow-up period was 27.5 months (range: 2-91 months). All patients underwent cyst excision with graft interposition, and the overall graft patency was 80.9 months (95% CI: 62.2-99.6 months).
Computed tomography, magnetic resonance imaging, and surgical findings confirmed communication between the synovial cyst and arterial adventitia. It is recommended that priority be given to surgical resection and graft interposition because this can eliminate the disease's cause and reduce its recurrence.
囊性血管外皮细胞瘤病是一种罕见的非动脉粥样硬化性疾病，影响各种动脉和静脉，涉及外膜内黏液性囊的形成。囊性血管外皮细胞瘤病的病因目前尚不清楚，有几种假说。本回顾性观察研究的目的是根据影像学和手术发现评估腘窝囊性血管外皮细胞瘤病的病因，并评估手术治疗的疗效。
2013 年 4 月至 2020 年 1 月，9 例患者被诊断为腘窝囊性血管外皮细胞瘤病并接受手术治疗。我们对囊肿和受影响的腘动脉段进行了完全切除，然后用自体倒置小隐静脉或大隐静脉进行间置。
切除的外膜囊肿组织呈多叶状，充满高粘度黏液。手术标本的病理检查显示，位于中膜和外膜之间的壁内囊肿充满胶状物质，符合囊性血管外皮细胞瘤病的临床诊断。中位随访时间为 27.5 个月（范围：2-91 个月）。所有患者均行囊肿切除术加移植物间置术，移植物总体通畅时间为 80.9 个月（95%可信区间：62.2-99.6 个月）。
计算机断层扫描、磁共振成像和手术发现证实了滑膜囊肿与动脉外膜之间的相通。建议优先进行手术切除和移植物间置，因为这可以消除疾病的病因并降低其复发率。
