Physician Detroit Medical Center Detroit, Michigan, United States
Case Diagnosis: Development of complex regional pain syndrome and left femoral nerve entrapment after multiple revascularization surgeries for critical limb ischemia
Case Description: 41 year old female with history of recurrent DVT’s who presented to the ED in 2018 with left leg pain, numbness and weakness. CT angiogram revealed thrombus within the descending thoracic aorta, and emboli within the left femoral artery, anterior tibial and peroneal arteries and dorsalis pedis artery. She underwent aortoiliac, left superficial femoral, profunda femoral, and tibial artery cutdown. In early 2019 she presented with left leg pain and was found to have critical limb ischemia requiring arteriogram, balloon angioplasty, pseudoaneurysm repair, and tPA catheter insertion. Over the next few months she developed worsening numbness, pallor, coolness, dysesthesias, and burning pain of the left leg, as well as weakened knee extension and gait disturbance. She had recurrence of critical limb ischemia in August 2019 and underwent recanalization and balloon angioplasty. MRI performed in October confirmed femoral nerve entrapment at the site of her left anterior groin wound.
Discussions: Complex regional pain syndrome is a complicated, chronic pain condition that often occurs after an injury or trauma. Symptoms can often vary however they often include pain, paresthesias, vasomotor changes, and skin trophic changes. While these can rarely occur after significant vascular procedures, this case demonstrates the development of CRPS type II due to femoral nerve entrapment. Her exam, months after surgery, revealed cool, pale skin with vasomotor changes, as well as paresthesias and allodynia. Her muscle strength was significant for quadriceps weakness which correlates with demonstrated femoral nerve entrapment on MRI. She continues to work with physical therapy to work on strength, function and mobility.
Conclusions: This is first case, to our knowledge, of the development of CRPS due to femoral nerve entrapment after critical limb ischemia and multiple revascularization surgeries.