Cystic Adventitial Disease: A Cause for Intermittent Claudication in Young Ages

Authors: Konstantinos A. Filis, MD, Fragiska Sigala, MD


Intermittent claudication in a healthy, middle-aged man who does not present with any of the traditional risk factors for arterial disease is rare and often misdiagnosed. In fact, a diagnosis of peripheral obstructive arterial disease in a nonsmoker, nondiabetic, nonhypertensive, and nonhyperlipidemic young male is difficult for a general physician to even contemplate, especially when the patient has palpable dorsalis pedis and posterior tibial arteries. Young, healthy patients who present with claudication resulting from popliteal artery stenosis due to external pressure, with intact arterial pulses, may have cystic adventitial disease (CAD). CAD is a cystic adventitial degeneration localized primarily in the popliteal artery. Although the pathogenesis of the disease remains controversial, what is certain is that the cystic degeneration is not primarily a dysplasia of the vessel wall itself, but originates from ectopic tissue of the joint capsule or bursa of the knee. Microscopic analysis of the cyst reveals collagenous and muscular fibers with focal necrosis, while the lumen is filled with mucinous, thick gelatinous fluid containing mainly amino acids.1 The cysts may be multiple or multiloculated. The pathology has been described as “subadventitial pseudocyst,” “mucinous cystic dissecting intramural degeneration,” “cystic mucoid degeneration,” and “cystic myxomatous adventitial degeneration.”

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1.Tsolakis IA, Walvatne CS, Caldwell MD. Cystic adventitial disease of the popliteal artery: diagnosis and treatment. Eur J Vasc Endovasc Surg 1998;15:188–194.
2.Cassar K, Engeset J. Cystic adventitial disease: a trap for the unwary. Eur J Vasc Endovasc Surg 2005;29:93–96.
3.Leu HJ, Largiader J, Odermatt B. Pathogenesis of the so-called cystic adventitial degeneration of peripheral blood vessels. Virchows Arch A Pathol Anat Histopathol 1984;404:289–300.
4.Owen ER, Speechly-Dick EM, Kour NW, et al. Cystic adventitial disease of the popliteal artery—a case of spontaneous resolution. Eur J Vasc Surg 1990;4:319–321.
5.Miller A, Salenius JP, Sacks BA, et al. Noninvasive vascular imaging in the diagnosis and treatment of adventitial cystic disease of the popliteal artery. J Vasc Surg 1997;26:715–720.