Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report

Abstract

Background: Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one's quality of life.

Case presentation: A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling.

Conclusion: The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.

Keywords: Case report; Extracorporeal membrane oxygenation; Femoral neuropathy.

Fig. 1

Computerized tomography image, schematic diagram, and nerve conduction study results. A computerized tomography image of the femoral artery and vein area, 2 weeks after extracorporeal membrane oxygenation (ECMO) cannula removal showing severe right leg swelling and intense residual thrombus within the femoral vein (a). Impaired conduction in the right femoral nerve conduction study is shown, compared with the left femoral nerve (b). A cross-sectional schematic image of the femoral area showing 1) external compression of the sheath within the vessels; and 2) severe generalized swelling of the right lower extremity causing compression to the femoral nerve (c). An illustration of arterial and venous sheaths of the ECMO inserted into the femoral and artery and vein, respectively, where large sheaths may cause external compression of the femoral nerve (d)