Adventitial Cystic Disease of the Common Femoral Artery: A Case Report and Literature Review
A 59-year-old man presented with a swelling of the left lower extremity that had begun two months earlier. He had diabetes mellitus and no history of trauma. No other specific sign was found on physical examination. At a local clinic, he received a diagnosis of deep vein thrombosis. For further evaluation, we performed computed tomography (CT) venography and pelvic magnetic resonance imaging (MRI). The CT venography axial images showed a 2.3 cm cystic mass compressing the left common femoral vein (). The MRI images showed a cystic mass compressing the left common femoral vein as well (). We suspected adventitial cystic disease (ACD) of the common femoral vein, and the patient underwent an operation. Under general anesthesia in a supine position, the femoral artery and vein were dissected for about 5 cm with a longitudinal incision on the left inguinal area. Surgical exploration showed an approximately 2.0 cm sized cystic mass that originated from the adventitia of the common femoral artery and was compressing the common femoral vein. The cyst that had adhered to the femoral artery was removed first, and the part of the wall that was attached to the cyst in the femoral artery was partially resected. Angioplasty was performed to repair the femoral artery whose wall was partially resected. Because the patient had had a partial circulation problem in the vein before the surgery and thus venous obstruction was possible, a polytetrafluoroethylene (PTFE) patch was used for angioplasty instead of using an autologous vein graft. A cystic mass excision with PTFE roofing angioplasty was performed and a gelatinous material exuded from the mass (). Microscopically, the presence of a mucinous cyst and vessel wall degeneration confirmed cystic adventitial disease of the common femoral artery (). The final diagnosis was ACD of the common femoral artery.