Adventitial Degeneration of the Popliteal Artery as a Rare Etiology of Impaired Arterial Circulation in the Lower Extremities

A 30-year-old female patient presented to the emergency department with a 3-day history of intermittently impaired sensory function and sensation of cold in the right foot. The lower extremities both exhibited the same coloring, were both warm, and exhibited no motor deficits. The lower leg as well as the lateral and dorsal foot were hypesthetic on the right lateral side. Duplex ultrasound showed a monophasic signal in the vessels of the lower leg and prompted suspicion of a popliteal artery aneurysm with risk of vascular occlusion. From a differential diagnostic perspective, peripheral arterial occlusive disease was considered, although the patient’s young age was untypical. Magnetic resonance imaging (MRI) with contrast-enhanced angiography was performed. This showed oval cystic structures associated with the popliteal artery and measuring up to 12 mm in diameter with consequent compression. This was caused by cystic adventitial degeneration. This rare disease primarily affects male patients (5:1) and is causal in 1/1200 cases of intermittent claudication. Surgical management revealed communication between the cysts and the joint space as well as inflammatory changes in the vessel wall over a 5-cm segment. This segment was removed and a vein interposition graft placed.

Figure

Magnetic resonance imaging (MRI)

Jakob Leonhardi, Samer Aldmour, Dr. med. Jeanette Henkelmann, Klinik und Poliklinik für Radiologie, Universitätsklinikum Leipzig, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Leonhardi J, Aldmour S, Henkelmann J: Adventitial degeneration of the popliteal artery as a rare etiology of impaired arterial circulation in the lower extremities. Dtsch Arztebl Int 2023; 120: 179. DOI: 10.3238/arztebl.m2022.0369