Wang Yuheng, Guo Chao, Huang Yi, Zhang Xinyang, Zhu Feng, Shang Dan
Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Vascular Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, 430074, China.
Thromb J. 2025 Jun 10;23(1):59. doi: 10.1186/s12959-025-00734-8.
Cystic adventitial disease (CAD) is a rare vascular condition that causes arterial stenosis due to the presence of a cyst in the adventitia (outer layer) of the artery. It is most commonly seen in young and middle-aged men, with an occurrence rate of around 0.1% among vascular diseases. Symptoms may include intermittent claudication, rest pain, and, in severe cases, ulcers or limb ischemia. CAD is often underdiagnosed due to its rarity and the broad range of differential diagnoses for arterial obstruction.
This case describes a 36-year-old female who presented with sudden left lower limb soreness that worsened with activity over five days, but without symptoms such as intermittent claudication or rest pain, which are typically associated with other vascular diseases. The patient had no significant history of smoking or other risk factors for peripheral arterial disease. Imaging studies, including angiography, revealed a focal filling defect and luminal narrowing in the popliteal artery (PA), which suggested the presence of an abnormality in the vessel wall. Given the findings and the patient's symptoms, surgical intervention was planned. The procedure involved the resection of the affected portion of the artery and replacement with an autologous vein graft. Pathological examination of the resected arterial segment confirmed the diagnosis of CAD, revealing a cyst in the adventitia filled with a gelatinous substance.
CAD is a rare but important cause of arterial obstruction and the etiology of CAD is still unclear. It should be considered in younger patients with symptoms of limb ischemia, especially without smoking history or traditional risk factors. Imaging techniques, such as ultrasound and CT/MRI angiography, are crucial for diagnosis. Surgical management, typically involving resection and autologous grafting, is often required to alleviate symptoms and prevent further vascular complications. However, it is worth mentioning that conservative treatments, such as avoiding triggering movements, are sometimes sufficient. Since CAD is rarely suspected, awareness of this condition can help in making an early diagnosis, potentially avoiding misdiagnosis and improving patient outcomes.
囊性外膜疾病（CAD）是一种罕见的血管疾病，由于动脉外膜（外层）出现囊肿而导致动脉狭窄。它最常见于中青年男性，在血管疾病中的发生率约为0.1%。症状可能包括间歇性跛行、静息痛，严重时会出现溃疡或肢体缺血。由于其罕见性以及动脉阻塞的鉴别诊断范围广泛，CAD常常被漏诊。
本病例描述了一名36岁女性，她出现左下肢突然酸痛，活动后五天加重，但没有间歇性跛行或静息痛等通常与其他血管疾病相关的症状。该患者无显著吸烟史或其他外周动脉疾病风险因素。包括血管造影在内的影像学检查显示腘动脉（PA）有局灶性充盈缺损和管腔狭窄，提示血管壁存在异常。根据检查结果和患者症状，计划进行手术干预。手术过程包括切除动脉的受累部分并用自体静脉移植物进行置换。对切除的动脉段进行病理检查确诊为CAD，显示外膜有一个充满胶状物质的囊肿。
CAD是一种罕见但重要的动脉阻塞原因，其病因仍不清楚。对于有肢体缺血症状的年轻患者，尤其是无吸烟史或传统风险因素的患者，应考虑到该病。超声和CT/MRI血管造影等影像学技术对诊断至关重要。通常需要进行手术治疗，一般包括切除和自体移植，以缓解症状并预防进一步的血管并发症。然而，值得一提的是，有时避免触发动作等保守治疗就足够了。由于CAD很少被怀疑，认识这种疾病有助于早期诊断，可能避免误诊并改善患者预后。
