A multi-institutional experience in adventitial cystic disease

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• 作者：Raghu L. Motaganahalli ; MD^a ; Matthew R. Smeds ; MD^b ; Michael P. Harlander-Locke ; MPH^c ; Peter F. Lawrence ; MD^c ; ^{pflawrence@mednet.ucla.edu} ; Naoki Fujimura ; MD ; PhD^d ; Randall R. DeMartino ; MD ; MS^e ; Giovanni De Caridi ; MD ; PhD^f ; Alberto Munoz ; MD^g ; Sherene Shalhub ; MD ; MPH^h ; Susanna H. Shin ; MD^h ; Kwame S. Amankwah ; MD ; MScⁱ ; Hugh A. Gelabert ; MD^c ; David A. Rigberg ; MD^c ; Jeffrey J. Siracuse ; MD^j ; Alik Farber ; MD^j ; E. Sebastian Debus ; MD ; PhD^k ; Christian Behrendt ; MD^k ; Jin H. Joh ; MD ; PhD^l ; Naveed U. Saqib ; MD^m ; Kristofer M. Charlton-Ouw ; MD^m ; Catherine M. Wittgen ; MDⁿ ; on behalf of the Vascular Low-Frequency Disease Consortium
• 刊名：Journal of Vascular Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：65
• 期：1
• 页码：157-161
• 全文大小：249 K
• 卷排序：65

文摘

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.MethodsUsing 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.ResultsForty-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.ConclusionsThis 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.