A multi-institutional experience in adventitial cystic disease

Raghu Motaganahalli, Matthew R. Smeds, Michael P. Harlander-Locke, Peter F. Lawrence, Naoki Fujimura, Randall R. DeMartino, Giovanni De Caridi, Alberto Munoz, Sherene Shalhub, Susanna H. Shin, Kwame S. Amankwah, Hugh A. Gelabert, David A. Rigberg, Jeffrey J. Siracuse, Alik Farber, E. Sebastian Debus, Christian Behrendt, Jin H. Joh, Naveed U. Saqib, Kristofer M. Charlton-OuwCatherine M. Wittgen

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Abstract

Background: Adventitial cystic disease (ACD) is an unusual arteriopathy; case reports and small series constitute the available literature regarding treatment. We sought to examine the presentation, contemporary management, and long-term outcomes using a multi-institutional database. Methods: Using a standardized database, 14 institutions retrospectively collected demographics, comorbidities, presentation/symptoms, imaging, treatment, and follow-up data on consecutive patients treated for ACD during a 10-year period, using Society for Vascular Surgery reporting standards for limb ischemia. Univariate and multivariate analyses were performed comparing treatment methods and factors associated with recurrent intervention. Life-table analysis was performed to estimate the freedom from reintervention in comparing the various treatment modalities. Results: Forty-seven patients (32 men, 15 women; mean age, 43 years) were identified with ACD involving the popliteal artery (n = 41), radial artery (n = 3), superficial/common femoral artery (n = 2), and common femoral vein (n = 1). Lower extremity claudication was seen in 93% of ACD of the leg arteries, whereas patients with upper extremity ACD had hand or arm pain. Preoperative diagnosis was made in 88% of patients, primarily using cross-sectional imaging of the lower extremity; mean lower extremity ankle-brachial index was 0.71 in the affected limb. Forty-one patients with lower extremity ACD underwent operative repair (resection with interposition graft, 21 patients; cyst resection, 13 patients; cyst resection with bypass graft, 5 patients; cyst resection with patch, 2 patients). Two patients with upper extremity ACD underwent cyst drainage without resection or arterial reconstruction. Complications, including graft infection, thrombosis, hematoma, and wound dehiscence, occurred in 12% of patients. Mean lower extremity ankle-brachial index at 3 months postoperatively improved to 1.07 (P < .001), with an overall mean follow-up of 20 months (range, 0.33-9 years). Eight patients (18%) with lower extremity arterial ACD required reintervention (redo cyst resection, one; thrombectomy, three; redo bypass, one; balloon angioplasty, three) after a mean of 70 days with symptom relief in 88%. Lower extremity patients who underwent cyst resection and interposition or bypass graft were less likely to require reintervention (P = .04). One patient with lower extremity ACD required an above-knee amputation for extensive tissue loss. Conclusions: This multi-institutional, contemporary experience of ACD examines the treatment and outcomes of ACD. The majority of patients can be identified preoperatively; surgical repair, consisting of cyst excision with arterial reconstruction or bypass alone, provides the best long-term symptomatic relief and reduced need for intervention to maintain patency.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StateAccepted/In press - Jun 6 2016

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ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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Motaganahalli, R., Smeds, M. R., Harlander-Locke, M. P., Lawrence, P. F., Fujimura, N., DeMartino, R. R., De Caridi, G., Munoz, A., Shalhub, S., Shin, S. H., Amankwah, K. S., Gelabert, H. A., Rigberg, D. A., Siracuse, J. J., Farber, A., Debus, E. S., Behrendt, C., Joh, J. H., Saqib, N. U., ... Wittgen, C. M. (Accepted/In press). A multi-institutional experience in adventitial cystic disease. Journal of Vascular Surgery. https://doi.org/10.1016/j.jvs.2016.08.079