Cystic adventitial disease of the common femoral artery presenting with acute limb ischemia.

Cystic adventitial disease (CAD) is a recognized cause of chronic lower limb ischemia. We present a case of CAD presenting as acute lower limb ischemia. A 54-year-old woman presented with a 48-hr history of sudden-onset right leg and foot pain associated with paresthesia and weakness. Duplex ultrasound and computed tomography angiogram showed acute occlusion of the common, superficial, and profunda femoral arteries. On surgical exploration, a mucinous cystic structure was found occluding the common femoral artery (CFA), which was later confirmed on histology as CAD. Because of the extent of the cyst, we treated this with an interposition graft, and the patient initially made a good recovery. However, 2 months later, she presented again with acute lower limb ischemia, and investigation and surgical exploration confirmed further cystic degeneration of the remaining part of the CFA. This case highlights a rare presentation and shows the importance of a high index of suspicion when investigating and treating young patients with lower limb symptoms, particularly when interpreting imaging.