Functional popliteal artery entrapment syndrome: use of ultrasound guided Botox injection as a non-surgical treatment option

Skeletal Radiol. 2017 Sep;46(9):1241-1248. doi: 10.1007/s00256-017-2686-6. Epub 2017 Jun 9.


Objective: To determine whether ultrasound-guided injection of botulinum toxin type A (BTX-A) is a viable alternative to surgical intervention for the treatment of functional popliteal artery entrapment syndrome (PAES).

Materials and methods: Twenty-seven patients met diagnostic criteria confirming the presence of functional PAES and agreed to go ahead with ultrasound-guided BTX-A injection at the level of artery occlusion. Patients were assessed and treated at baseline and given the option for 'top-up' injections at 6 and 12 months. Patients provided subjective symptom reports at 6 and 12 months post intervention.

Results: No patients reported being worse off after the intervention; 59% of patients were categorized as having a good response (i.e., initial improvement that was maintained at 12 months), 22% a mixed response (i.e., an initial improvement that subsequently reduced over 12 months) and 19% a poor response (i.e., no difference) to treatment.

Conclusions: Ultrasound-guided BTX-A injection represents a viable alternative to surgery in the treatment of functional PAES. Further study will help determine the optimum dose and frequency of injection to prevent recurrence of symptoms.

Keywords: Botox injection; Claudication; Functional popliteal artery entrapment syndrome.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arterial Occlusive Diseases / drug therapy*
  • Botulinum Toxins, Type A / therapeutic use*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Agents / therapeutic use*
  • Popliteal Artery*
  • Treatment Outcome
  • Ultrasonography, Interventional*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A