CAD remains a rare cause of lower-limb ischaemia, with a prevalence of 0.1% among patients with intermittent claudication.5 The exact aetiology of CAD is not known, although four theories about its pathogenesis have been postulated: trauma theory, ganglion theory, systemic disorder theory, and developmental theory.6
Historically, surgical treatment of CAD is preferred over endovascular or minimally invasive techniques owing to the considerably lower recurrence rates after surgery. The main surgical treatments are resection of the affected popliteal arterial segment with interposition of an autologous vein graft and cyst enucleation. Original articles and textbooks recommend popliteal artery resection with graft interposition only in the presence of arterial occlusion or involvement of the media2, 7; however, many vascular surgeons prefer this method even in cases in which the artery is not completely occluded.8
Percutaneous endovascular interventions, such as angioplasty and stenting, have been attempted, with unsatisfactory results. Endarterectomy and endovascular interventions do not directly address CAD, which originates from the adventitial layer of the artery. As a result, early recurrence is almost guaranteed to occur (as early as 8 h after treatment in some cases).2, 8 Only one case of CAD recurrence successfully treated with balloon angioplasty has been reported, in which the patient had previously undergone surgical excision.9 Nevertheless, in our case, the decision to perform interventional treatment was based on the patient’s history of percutaneous thrombectomy for the removal of a thrombus from the postoperative popliteal artery 2 months previously and on the misdiagnosis of thrombotic occlusion based on CTA findings. Angiography and Doppler US revealed an accompanying recurrence; however, it was difficult to perform surgery immediately and intravascular treatment was performed instead. We considered that the atherectomy device would destroy the cyst wall and consequently allow the drainage of internal fluids. However, the destruction of the cyst wall was insufficient even with atherectomy and balloon angioplasty, and CAD recurred the day after the procedure.
This is the first reported case in which atherectomy was performed for recurrent CAD. Our experience showed that endovascular treatment is not satisfactory for CAD recurrence, even with atherectomy. Although recurrence after the primary surgical treatment of CAD remains rare, similar symptoms may be observed once it occurs. The application of atherectomy was found to be unsatisfactory in this case. This report highlights the pitfalls which can be avoided by selecting surgical resection as a therapeutic approach.