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Non atherosclerotic diseases producing intermittent claudication in middle-aged men are rare, but they are an important minority. Cystic adventitial disease (CAD) is one of these entities; its more frequent location is the popliteal artery. We describe an unusual case of CAD involving common femoral artery in young. Early and careful diagnosis (by Doppler Ultrasonography or Computed Tomography Angiography) and prompt repair appear crucial to achieve good outcomes. The diagnosis was made during the surgical procedure carried out for severe intermittent claudication. Surgical treatment with total excision of the lesion and arterial reconstruction with PTFE prothesis provides a complete resolution of the symptoms. We review the literature about non-atherosclerotic causes of lower extremity claudication, describing etiology, diagnosis and treatment. Conditions including popliteal artery entrapment syndrome, pseudoxanthoma elasticum, iliac fibromuscular disease, persistent sciatic artery, iliac/femoral giant cell arteritis and iliac endofibrosis are described. As the low incidence of these lesions and the poor literature data, the authors suggest that all patients with intermittent claudication without atherosclerotic disease should be investigated to look for these syndromes.

Accidental supra-aortic arterial cannulation during central venous catheter (CVC) insertion is a rare and serious complication associated with risk of vascular and neurologic complications. The aim of this study is describing our 6 cases experience and propose a management algorithm. We retrospectively evaluated the diagnosis and treatment of six patients arrived at our Department for accidental supra-aortic arterial cannulation during CVC insertion. They underwent Doppler Ultrasonography (DUS) or Computed Tomography Angiography (CTA) to confirm the arterial damage and to decide the correct therapeutic pathway. Four patients underwent DUS as the shallow location of injured arteries and 2 patients CTA because of the arterial damage deeply located. Surgical procedure with direct arterial suture was performed in four patients. Endovascular treatment with stent graft deployment was carried out in two patients. All procedures were conducted successfully: technical success (immediate hemostasis and vessel patency) was obtained in 100% of the cases. Postoperative imaging (DUS or CTA) confirmed the absence of arterial bleeding and the arterial patency. No perioperative mortality or complications occurred. After a careful review of literature and our case series, we proposed an algorithm to delineate the optimal treatment strategy, explaining that early and careful diagnosis (by DUS or CTA) and prompt repair appear crucial to achieve good outcomes and clarifying that an endovascular technique (stent graft placement or vascular closure device) seems to be the best treatment in these cases. Finally, an open surgical technique could be indicated in case of common carotid artery injury and concurrent catheter passing through the target vein., (Copyright © 2021. Published by Elsevier Inc.)