0:00

A less common disease of the artery

0:02

that we encounter is the cystic advent disease.

0:06

I have very little experience with this.

0:08

Um, this is an old case, uh,

0:11

from Scripps Hospital when we used to work there

0:14

of bilateral cystic adventitial disease in a patient

0:18

that had, uh, symptomatic claudication, uh,

0:22

in a 30-year-old, uh, female.

0:24

But, you know, honestly, I don't know

0:26

how these are getting diagnosed because I look at this area

0:30

and I see this, uh, very, very, uh, rarely.

0:33

I'll show you a couple of examples.

0:36

Uh, this is another patient,

0:39

and again, it's, uh, the cystic collection.

0:43

It was intimate with the vessel.

0:45

Uh, but you can see this nice correlative angiogram.

0:48

This is an older case again,

0:50

where they did conventional angiography,

0:52

and it's showing you the simar sign, uh,

0:55

where the vessel is narrowed, uh, related, uh, to these,

0:59

um, to these cysts.

1:01

So these tend to be generally seen in younger males.

1:05

They can be bilateral,

1:07

and the most common site of this is the popliteal artery.

1:10

Here we see another example, a more recent case.

1:14

This patient was a bit older,

1:16

and we have this very complicated cystic collection

1:20

that's intimate, uh, with the, a popliteal artery.

1:23

You can see it's being deviated.

1:25

You can understand how this could produce that Simar sign,

1:28

which is really characteristic of this.

1:31

But what I think is really interesting is

1:34

what we've been learning more recently from work by spinner

1:39

who has done a lot of articles on perineural, uh,

1:43

ganglia and has written a lot about ganglia at the proximal

1:47

tibial fibular joint.

1:49

And he believes that these are of articular origin.

1:53

So these are some of the etiologies that have been pro, uh,

1:57

um, suggested

1:59

for cystic adventitial disease trauma

2:03

degeneration from a systemic process, some remnant cells

2:07

during development, but in spinners opinion,

2:11

and I think he's right, um, these actually are coming, uh,

2:16

from the joint and the, we seek examples like this

2:20

where you have cystic adventitial disease

2:24

around the artery, clearly, uh,

2:27

what you would call cystic adventitial disease.

2:30

But the patient also has peric cruciate ganglia.

2:35

Sometimes they have intercondylar notch ganglia.

2:39

Um, and, uh, you know, uh, his idea is, is

2:43

that these dissect along the posterior

2:48

knee, along that, uh, middle gen artery

2:52

that I illustrated for you earlier.

2:54

This is another case.

2:55

Uh, this was a case that was actually post

2:58

Contrast and it filled some of these cysts

3:01

inside the joint.

3:03

And then you can see this track going outside,

3:07

running alongside the popliteal artery.

3:10

So his theory is that you get ganglia

3:14

and instead of coming up along a nerve,

3:17

they come up along a vessel and then can dissect from that

3:21

and extend along the branches of the superior

3:25

and inferior, uh, geniculate uh, artery.

3:28

So I think this is interesting.

3:30

I don't have a big enough collection to be sure,

3:32

but I've noticed this communication long time ago never had

3:37

an explanation for it until, uh, this article from Spinner.

3:41

So this is that middle gen nuclear artery.

3:43

This is the case I already showed you with that artery here.

3:47

And this is taken from, uh, an anatomy article by

3:52

BVI with the dissection showing you this branch.

3:56

It's an unpaired single branch at the

3:59

middle of the knee joint.

4:00

Um, and again, you can get ganglia, uh, tracking along it.

4:05

You can get tumor, uh, tracking along it.

4:07

You can get infection tracking out of the capsule, um,

4:10

along this area.

4:11

So, uh, here's its course.

4:13

Usually comes off a little bit high of joint line

4:17

and then dives down

4:18

to enter into the posterior, uh, capsule.

4:21

Just a little anatomy thing, uh, to be aware of.

4:25

We also used to see these central ganglia,

4:28

and I never knew what caused these, uh,

4:30

but I think they're dehiscing like right along

4:33

that same capsular, uh, issue.

4:36

In this example here, normal on your left, uh, the ganglion

4:40

or cyst from the knee heading out.

4:43

This one did not look like a cystic adventitial disease,

4:47

but it shows that same area of the defect with

4:50

how there's this potential communication

4:53

with the popliteal fossa through that, uh, through

4:56

that area in the, in the capsule, which is dehi,

5:00

where the vessel, uh, enters it.