Cystic adventitial disease of the popliteal artery presenting with features of entrapment syndrome

Cystic adventitial disease is an uncommon cause of lower extremity claudication resulting from accumulation of mucinous fluid in an arterial subadventitial layer, typically of the popliteal artery. A popliteal bruit and/or reduced distal pulses with knee flexion may be seen on examination. Alternatively, popliteal artery entrapment syndrome triggers claudication via an aberrant arterial pathway or muscular hypertrophy. Decreased distal pressures with plantar or dorsiflexion is a key finding. This report details the case of a middle-aged male with cystic adventitial disease whose diagnosis was complicated by concurrent features of popliteal artery entrapment syndrome. Treatment consisted of venous interposition grafting, which yielded excellent results.