Treatment of Functional Popliteal Artery Entrapment Syndrome with Ultrasound-Guided Botox Injection

Abstract

Popliteal artery entrapment syndrome is an uncommon and underreported cause of lower limb claudication. In the absence of appropriate treatment, it increases the risk of limb ischemia, popliteal artery damage, and embolization. Two subtypes include functional popliteal artery entrapment syndrome (FPAES) and the anatomic subtype ( 1 Sinha S. Houghton J. Holt P.J. et al. Popliteal entrapment syndrome. J Vasc Surg. 2012; 55: 252-262 Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar ). The functional subtype is more common and particularly prevalent in young active athletic women ( 2 Hislop M. Brideaux A. Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017; 46: 1241-1248 Crossref PubMed Scopus (14) Google Scholar ). Given the rare incidence of FPAES as a cause for limb claudication, it continues to be an imaging and clinical diagnostic challenge. Modified ultrasound (US) and magnetic resonance (MR) imaging protocols have been published to improve the diagnostic accuracy of FPAES ( 2 Hislop M. Brideaux A. Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017; 46: 1241-1248 Crossref PubMed Scopus (14) Google Scholar ). Also, US-guided injection of botulinum toxin type A (BTX-A) for treating FPAES as a viable alternative to surgery has been reported ( 2 Hislop M. Brideaux A. Dhupelia S. Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option. Skeletal Radiol. 2017; 46: 1241-1248 Crossref PubMed Scopus (14) Google Scholar , 3 Hislop M. Kennedy D. Cramp B. Dhupelia S. Functional popliteal artery entrapment syndrome: poorly understood and frequently missed? A review of clinical features, appropriate investigations, and treatment options. Journal of Sports Medicine. 2014; 2014: 105953 Google Scholar ). The following report was exempt from approval by the institutional review board.