Ultrasound-guided placement of a permanent percutaneous femoral nerve stimulator leads for the treatment of intractable femoral neuropathy.
BACKGROUND
Femoral nerve injury is a rare complication of cardiac catheterization and is usually caused by direct trauma during femoral artery access, compression from a hematoma, or prolonged digital pressure for post-procedural hemostasis. Peripheral nerve stimulation has been used to treat different pain syndromes in the upper and lower extremities with variable success and it typically requires direct vision with open surgical approach. Since the femoral nerve can be readily seen with ultrasonography, an ultrasound-guided lead placement seemed practical.


METHODS
A 61-year-old morbidly obese male who sustained femoral nerve injury during cardiac catheterization continued to complain of intractable femoral neuropathy 18 months afterwords. He failed multiple treatment modalities and continued to complain of severe neuropathic pains that markedly interfere with his daily activities. Two percutaneous leads were placed under real-time ultrasonography and the placement was confirmed with fluoroscopy. One lead was placed along the longitudinal axis of the nerve and the patient had good coverage over the anterior thigh but not below the knee. So another lead was placed horizontally across the femoral nerve in order to stimulate all the branches and the patient reported good coverage along the saphenous nerve distribution down to the foot.


RESULTS
The patient continues to be pain free 20 months after the implant.


CONCLUSIONS
Here we described a novel non-invasive percutaneous approach for femoral nerve stimulation with ultrasound guidance which allowed precise placement of the stimulating lead very close to the femoral nerve without the need for surgical exploration.
Narouze
Samer N
SN
Pain Management Department, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH 44195, USA. narouzs@ccf.org
Zakari
Adel
A
Vydyanathan
Amaresh
A
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects; D020428:Femoral Neuropathy / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery; D004561:Transcutaneous Electric Nerve Stimulation / Q000295:instrumentation / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*