Long-Segment Adventitial Cystic Disease of the Popliteal Artery Requiring Adductor Hiatus Division: A Case Report

BackgroundAdventitial cystic disease (ACD) of the popliteal artery is a rare cause of intermittent claudication, typically presenting as a focal lesion, with long-segment involvement being even more uncommon.Case SummaryA 53-year-old man presented with progressive left calf claudication for one year, worsening over the last 6 months. Imaging studies, including computed tomography and magnetic resonance imaging, identified a cystic lesion compressing the popliteal artery, with duplex ultrasound estimating its length at 6 cm. However, intraoperative findings revealed the lesion extended over 10 cm into the adductor hiatus. To achieve proximal control, adductor hiatus division was required. The cystic segment was resected, and a great saphenous vein interposition graft was placed. The patient recovered uneventfully with complete symptom resolution.ConclusionThis case highlights the feasibility of a posterior approach with adductor hiatus division for long-segment ACD, emphasizing the importance of thorough preoperative assessment and tailored surgical planning.