Ohta T, Kato R, Sugimoto I, Kondo M, Tsuchioka H
Second Department of Surgery, Aichi Medical University, Japan.
Surgery. 1994 Sep;116(3):587-92.
A case of cystic adventitial disease (CAD) of the popliteal artery with intermittent claudication in the left calf is reported. This patient was first treated by total excision of the cyst and the involved artery followed by graft interposition with an autogenous saphenous vein. Recurrence of CAD in the interposed vein graft was noted after 6 months, and excision of the cyst with the involved graft and graft interposition with an autogenous saphenous vein was again required. We consider that the definitive evidence from early recurrence in the interposed vein graft shown in this case will close the discussion of the cause of CAD. The cystic lesion is thought by some to originate from the adventitia; traumatic, embryologic, or systemic abnormality theories were proposed. We assume that the mucin-secreting synovial cells originating from the neighboring joint capsule, tendon sheath, or, in some cases, from the ganglion itself, directly invade the adventitia through any rough or injured crack caused by trauma to the adventitia or simply attach to and encircle the adventitia. Total resection of the lesion with grafting is the recommended treatment for CAD because of the excellent results. However, as shown in our case, complete removal of the synovial cells even by resection technique may be difficult; therefore intensive follow-up is fundamentally necessary in this disease.
报告一例左侧小腿间歇性跛行的腘动脉囊性外膜疾病（CAD）病例。该患者最初接受了囊肿及受累动脉的全切术，随后用自体大隐静脉进行移植。6个月后发现移植的静脉移植物中CAD复发，再次需要切除囊肿及受累移植物并用自体大隐静脉进行移植。我们认为，该病例中移植静脉移植物早期复发的明确证据将结束关于CAD病因的讨论。一些人认为囊性病变起源于外膜；有人提出了创伤、胚胎学或全身异常理论。我们假设，起源于相邻关节囊、腱鞘或在某些情况下起源于神经节本身的分泌粘蛋白的滑膜细胞，通过外膜创伤导致的任何粗糙或损伤裂缝直接侵入外膜，或简单地附着并环绕外膜。由于效果良好，推荐对CAD进行病变全切并移植治疗。然而，如我们的病例所示，即使通过切除技术也可能难以完全清除滑膜细胞；因此，对这种疾病进行密切随访从根本上来说是必要的。
