Effective Management of Cystic Adventitial Disease of the Popliteal Artery Using the Modified Sims’ Position

Abstract

Different approaches and surgical positions are available for approaching the popliteal artery depending on lesion location. A posterior approach in the prone position is most frequently used for treating cystic adventitial disease (CAD) of the popliteal artery. Herein, we report a case that was effectively managed using the modified Sims’ position as a surgical position for a wide range of CADs of the popliteal artery, extending from the distal part of the superficial femoral artery to the total length of the popliteal artery. The patient was a 64-year-old woman who complained of intermittent claudication 6 months ago. She was diagnosed with arteriosclerosis obliterans for which she underwent endovascular treatment. At that time, she underwent an intravascular ultrasonography (IVUS) which detected multiple cystic lesions around the popliteal artery. Thus, endovascular treatment was discontinued and she was subsequently discharged. During an outpatient follow-up, she underwent contrast-enhanced computed tomography and magnetic resonance imaging, which revealed that the polycystic lesion compressed the right popliteal artery and caused complete occlusion of the lumen. Therefore, she was diagnosed with CAD of the popliteal artery. The proximal portion of the cystic lesion was extended to the superficial femoral artery, which was thought to be inaccessible using the posterior approach alone. The use of both the anterior and posterior approaches using the modified Sims’ position allowed extensive arteriectomy and revascularization without changing intraoperative posture. In cases of extensive lesion developing beyond the popliteal artery, the modified Sims’ position may be useful.