PMC5537433_01
Pre- and post-operative CT scan images show pathogenesis and cure of adventitial cystic disease. (a) Preoperative axial CT image shows that the developed cystic lesion was compressing the popliteal artery of the right leg (indicated by white arrowhead). Inset, CT image enlarged at the cystic lesion. (b) Reconstituted three-dimension CT image apparently demonstrates the stenosis of the right popliteal artery (white arrowhead). (c) Postoperative CT image indicates no recurrence of the cyst (white arrowhead) six months after surgery.
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While ankle brachial pressure index (ABI) was normal (1.13/1.13), computed tomography (CT) scan with contrast indicated popliteal artery stenosis due to cystic lesion (Fig. 1a and b). No recurrence of stenosis or cyst has been found by CT scan 6 months after operation (Fig. 1c).
Operative views including surgical fields of the cystic lesion at the popliteal artery. (a) Before surgery, the site of the adventitial cyst (black cross) and the short saphenous vein (red line) were directly marked on the surface of the skin in a prone position. (b) At surgery, adventitial cyst at the popliteal artery exhibits severe adhesion to neighboring tissues. (c) The popliteal artery developing the cyst was resected and was replaced by the short saphenous vein. The length of the blood vessel including the cyst was approximately 2 cm. (d) Resected popliteal artery revealed that the cyst was unilobular, filled with high-viscosity mucus, and developed around the popliteal artery semi-circumferentially.
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Surgical procedure: We marked the short saphenous vein when the patient was in a prone position (Fig. 2a), as we intended to employ a small piece of the short saphenous vein in this bypass grafting surgery. At surgery, it was revealed that the right popliteal artery had been compressed by an adventitial cyst (2 x 1 x 1 cm) (Fig. 2b). The lesional popliteal artery including the adventitial cyst was resected and then replaced by the short saphenous vein (Fig. 2c). The cyst developed around the popliteal artery semi-circumferentially (Fig. 2d).