200 Section - Anterior Femoral Cutaneous Nerve Injury Following Femoral Catheterization Procedure: A Case Report

Anterior Femoral Cutaneous Nerve (AFCN) Injury Following Femoral Catheterization

Case Description:

A 53-year-old man with left internal carotid artery dissection and middle cerebral artery infarct underwent thrombectomy and carotid stenting via right femoral access, complicated by post-operative groin hematoma. He achieved near-complete motor recovery from right hemiparesis but experienced right hemibody neuropathic pain two months after stroke with allodynia and hyperalgesia features, partially responding to anti-depressants and opioids. Over five years, his hemibody pain improved significantly although he developed persistent right groin and inner thigh pain, described as sharp, pricking, or burning, with intermittent radiation down the leg. He was diagnosed with inguinal hernia and underwent hernioplasty with mesh without symptom relief. At our centre, physical examination revealed right hemisensory loss and reproduction of pain in anteromedial right thigh from palpating mid-portion of inguinal ligament, raising suspicion of AFCN pathology. Ultrasound-guided diagnostic and therapeutic right intermediate femoral cutaneous nerve hydrodissection was performed, with complete symptom resolution after one month.

Discussions:

AFCN is susceptible to injury during femoral arterial access from its proximity to femoral vessels and superficial course in proximal thigh. Resultant neuropathic pain can be persistent and difficult to recognize, particularly in patients with concurrent neurologic conditions. AFCN injury typically occurs through direct trauma during femoral catheterization or prolonged digital compression for hemostasis. Patients typically present with sensory disturbances such as burning or numbness in anteromedial thigh, ranging from mild sensory loss to severe neuropathic pain. Diagnosis is primarily clinical, based on characteristic pain distribution and clinical sensory findings. Ultrasound-guided hydrodissection is a precise technique to relieve perineural tethering/compression and may offer diagnostic confirmation and therapeutic benefit.

Conclusions:

AFCN-related neuralgia is an uncommon but clinically important complication of femoral catheterization that can cause prolonged focal groin/anterior thigh neuropathic pain. Ultrasound-guided hydrodissection may provide targeted decompression and symptom resolution when conservative measures fail.