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Cystic adventitial disease is a rare disorder that occurs in peripheral arteries. Calf claudication caused by compression of the popliteal artery is a typical presentation of this disease. This is a report of two cases of occluded popliteal artery decompression by percutaneous ultrasound-guided cyst aspiration. In both cases, decompression of the artery was achieved with a significant decrease in the size of adventitial cysts and restoration of flow. Both patients reported complete resolution of symptoms and no calf pain 5 years after the procedure. MR findings and resolution of symptoms in these two patients show the efficacy of percutaneous adventitial cyst aspiration in a 5-year follow-up.