Femoral neuropathy as a complication of aortic surgery

In a series of 1006 aortic operations for atherosclerotic occlusive or aneurysmal disease a femoral neuropathy with paresis of the quadriceps femoris muscle and sensory disturbances occurred in 34 patients or 3.4%. The femoral nerve palsy was left-sided 23 times, right-sided 9 times and bilateral twice. Twenty-nine patients had a complete recovery after 1/2 to 1 years. It is suggested that the femoral neuropathy is of ischaemic nature and caused by aortic clamping. The scant blood supply of the intrapelvic section of the femoral nerve is derived from the iliolumbar artery, a branch of the internal iliac artery, and from the deep circumflex iliac artery, a branch of the external iliac artery. On the right side the deep circumflex iliac artery gives more branches to the nerve and there are more anastomoses with the fourth and fifth lumbar arteries, than on the left side. This may be the explanation for the preference of the nerve palsy for the left side.