Popliteal artery cystic adventitial disease: An uncommon cause of claudication

Cystic adventitial disease of the popliteal artery is an uncommon vascular condition that can manifest as intermittent claudication, particularly in active individuals without typical atherosclerotic risk factors. We report the case of a 50-year-old male presenting with a 2-year history of progressive right leg pain, triggered by prolonged walking and knee flexion, yet notably absent during cycling activities. Clinical examination revealed diminished distal pulses in the right leg. A Doppler-based treadmill test indicated a significant post-exercise drop in ankle pressures on the right side. Ultrasound and MRI confirmed a cystic lesion encasing the right popliteal artery, ruling out other potential diagnoses. Surgical excision of the cyst and reconstruction of the affected arterial segment with a reversed small saphenous vein graft led to complete resolution of the symptoms. Six-month follow-up showed graft patency and no recurrence. This case underscores the importance of considering cystic adventitial disease in differential diagnoses of exertional leg pain in patients without typical vascular risk factors, and it highlights the effectiveness of surgical intervention in achieving favorable outcomes.