Cystic adventitic degeneration

from Wikipedia, the free encyclopedia
Cystic adventitic degeneration of the popliteal artery in an otherwise vascularly healthy man. Angiography shows the sharp, arched narrowing of the cyst.
MRI of the same patient: You can see the T2-weighted cysts on the vessel wall. Ganglia on the meniscus were also detectable.

The Cystic adventitial is a rare vascular disease, especially in the popliteal artery to stenoses or obstructions by cystic formations in the adventitia may result. The symptoms may therefore be similar to those of peripheral arterial disease , but in most cases it affects the elderly.

Initial description

The disease was first described in 1947 by Atkins and Key in the iliac artery . The naming is ascribed to Hiertonn, Lindberg and Rob (1957).

Occurrence

It mainly affects men between 30 and 50 years of age, with an estimated incidence of 1 in 1200 cases of intermittent claudication , the male: female gender ratio is around 5: 1. Bilateral occurrences and involvement of smaller arteries in the knee have been described.

Veins are much less diseased than arteries. The symptoms then correspond to those of a thrombosis or even occur.

Pathogenesis

For the development of the cysts that occur exclusively in the adventitia and contain proteins and mucopolysaccharides , three main variants are discussed:

  1. Reports of a connection to the neighboring knee joint support the assumption that it is a real ganglion that has expanded into the vessel wall. A histochemical examination also concludes that there is a synovial origin.
  2. Other authors assume that embryonic tissue has been dispersed from the joints into the neighboring vessels.
  3. The thesis that repeated microtraumas are the cause is considered less likely.

Due to the mentioned theories about the origin of the term mainly used in the English language appears cystic adventitial disease : (German Cystic Adventitiaerkrankung , suitable as a degeneration of the adventitia is not proven as such cause).

Diagnosis

Clinically, the clinical picture presents itself with changing symptoms, which show a dependence on the load on the affected knee joint. The circulatory disorders can be triggered or intensified in the sense of a provocation test by bending the knee joint. As diagnostic imaging is next to the ultrasound with duplex sonography , the computed tomography and specific and without radiation exposure to magnetic resonance imaging used. This often shows chambered, round to elongated oval cysts in the vessel wall. Any additional ganglia on the knee joint can be recorded in the same examination. The cysts are signal-intensive in T2-weighted images, low-signal in T1-weighted images and do not absorb any contrast medium. The angiography shows a circumscribed, sharply defined, bogige filling defect that can occur several times and from both sides, depending on the extent of the cysts in otherwise bland usually vessels. One speaks of the scimitar sign ( scimitar = scimitar ). This term originally used in conventional angiography is now also used in magnetic resonance tomography, especially in MRA .

In terms of differential diagnosis, in addition to arteriosclerotic PAOD and aneurysms, the arteria-popliteal compression syndrome in most of the younger patients should be considered.

therapy

Attempts to correct the constriction of the vessel by puncturing and emptying the cyst (s) often led to recurrences , so that in most cases, surgical rehabilitation by resection of the cyst and patch plasty is sought today. If the findings are too extensive, a resection of the entire vessel with restoration through a body's own vein or a so-called exarterectomy may be necessary. The adventitia in the affected area is completely removed in a circular manner without opening the media . The complete resection of further cysts in the soft tissues and the ligature of any existing connection to the joint is recommended.

Web links

Commons : Cystic Adventitarian Degeneration  - Collection of Images, Videos and Audio Files

Individual evidence

  1. ↑ a b S. C. Paravastu, JM Regi u. a .: A Contemporary Review of Cystic Adventitial Disease. In: Vascular and endovascular surgery , December 2011, ISSN  1938-9116 . doi: 10.1177 / 1538574411419377 . PMID 22169114 .
  2. ^ HJ Atkins, JA Key: A case of myxomatous tumor arising in the adventitia of the left external iliac artery; case report. In: British Journal of Surgery , Volume 34, Number 136, April 1947, p. 426, ISSN  0007-1323 . PMID 20247247 .
  3. ↑ T. Hiertonn, K. Lindberg, C. Rob: Cystic degeneration of the popliteal artery. In: The British Journal of Surgery , Volume 44, Number 186, January 1957, pp. 348-351, ISSN  0007-1323 . PMID 13510590 .
  4. ↑ a b c d e f g H. Diener et al. Compression syndromes of the popliteal artery - differential diagnostic chameleon of acute claudication . ( Memento of the original from May 20, 2012 in the Internet Archive ; PDF; 1.2 MB) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: Hamburger Ärzteblatt Online , 2006 @1@ 2Template: Webachiv / IABot / www.aerztekammer-hamburg.de
  5. ↑ DP Flanigan, SJ Burnham, JJ Goodreau, JJ Bergan: Summary of cases of adventitial cystic disease of the popliteal artery. In: Annals of Surgery , Volume 189, Number 2, February 1979, pp. 165-175, ISSN  0003-4932 . PMID 426549 . PMC 1397030 (free full text).
  6. ^ M. França, J. Pinto, R. Machado, GC Fernandez:Case 157: bilateral adventitial cystic disease of the popliteal artery .  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. In: Radiology. Volume 255, Number 2, May 2010, pp. 655-660, ISSN 1527-1315 . doi: 10.1148 / radiol.10082211 . PMID 20413777 .@1@ 2Template: Dead Link / radiology.rsna.org    
  7. ^ EA Ypsilantis, PV Tisi: Involvement of the genicular branches in cystic adventitial disease of the popliteal artery as a possible marker of unfavorable early clinical outcome: a case report . In: Journal of medical case reports , Volume 4, 2010, p. 91, ISSN  1752-1947 . doi: 10.1186 / 1752-1947-4-91 . PMID 20298598 . PMC 2845145 (free full text).
  8. ↑ a b Hach-Wunderle V., Präve F., Hanschke D., Gruss JD, Hach, W .: The cystic adventitic degeneration of the veins . In: Vascular Surgery May 2003 doi: 10.1007 / s00772-003-0268-5
  9. ^ AP Gasparis, P. Wall, JJ Ricotta: Adventitial cystic disease of the external iliac vein presenting with deep venous thrombosis. A case report. In: Vascular and endovascular surgery. Volume 38, Number 3, 2004 May-Jun, pp. 273-276, ISSN  1538-5744 . PMID 15181511 . (Review).
  10. ↑ AL Deutsch, J. Hyde u. a .: Cystic adventitial degeneration of the popliteal artery: CT demonstration and directed percutaneous therapy . In: American Journal of Roentgenology . Volume 145, Number 1, July 1985, pp. 117-118, ISSN  0361-803X . PMID 3873831 .
  11. ↑ L. di Marzo, C. Della Rocca et al. a .: Cystic adventitial degeneration of the popliteal artery: lectin-histochemical study. In: European Journal of Vascular Surgery . Volume 8, Number 1, January 1994, pp. 16-19, ISSN  0950-821X . PMID 8307209 .
  12. ^ LJ Levien, CA Benn: Adventitial cystic disease: a unifying hypothesis. In: Journal of Vascular Surgery . Volume 28, Number 2, August 1998, pp. 193-205, ISSN  0741-5214 . PMID 9719314 . (Review).
  13. ^ A b K. Cassar, J. Engeset: Cystic adventitial disease: a trap for the unwary. In: European Journal of Vascular and Endovascular Surgery . Volume 29, Number 1, January 2005, pp. 93-96, ISSN  1078-5884 . doi: 10.1016 / j.ejvs.2004.09.006 . PMID 15570280 .
  14. ↑ K. Ishikawa, Y. Mishima, S. Kobayashi: Cystic adventitial disease of the popliteal artery. In: Angiology. Volume 12, August 1961, pp. 357-366, ISSN  0003-3197 . PMID 13718004 .