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Sciatic nerve lesions during cardiac surgery
1Department of Neurology, Mayo Clinic and Foundation, Rochester, MN 55905.
Insights
Cardiac surgery patients rarely develop sciatic nerve lesions. Prolonged femoral artery catheterization or occlusion, combined with hypoxia, increases the risk of sciatic neuropathy and potential muscle ischemia.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Vascular Surgery
Background:
- Sciatic nerve lesions are uncommon complications in cardiac surgery patients.
- Previous literature has not extensively detailed the etiologies of sciatic neuropathy in this population.
Purpose of the Study:
- To investigate the potential causes of sciatic neuropathy in patients undergoing cardiac surgery.
- To identify risk factors associated with the development of sciatic nerve damage post-cardiac surgery.
Main Methods:
- Retrospective review of cardiac surgery patients over 15 years at a single institution.
- Analysis of medical records for six patients diagnosed with sciatic neuropathy.
- Clinical examination and electromyography (EMG) in a subset of patients.
Main Results:
- Four of six patients had prolonged intra-aortic balloon pump (IABP) therapy with ipsilateral femoral artery catheterization.
- Two patients had ipsilateral femoral artery occlusion.
- Four patients had severe peripheral vascular disease; one experienced prolonged perioperative hypoxia.
- EMG revealed femoral nerve or quadriceps muscle damage in two patients, suggesting potential muscle ischemia.
Conclusions:
- Patients undergoing cardiac surgery are at risk for sciatic neuropathy, particularly with compromised femoral artery blood flow and concurrent tissue hypoxia.
- Asymptomatic ischemia of the femoral nerve and quadriceps muscles may occur in this patient cohort.
- Risk factors include IABP use, femoral artery occlusion, peripheral vascular disease, and perioperative hypoxia.
Abstract:
Sciatic nerve lesions occur only rarely in cardiac surgery patients. To evaluate potential causes for sciatic neuropathy, we reviewed the cardiac surgery performed at one institution during the last 15 years and found only six instances of sciatic neuropathy. We examined medical records for these six patients for potential etiologic factors and determined that four of the six patients had undergone prolonged periods of intra-aortic balloon pump therapy with a catheter placed through the femoral artery ipsilateral to the sciatic nerve lesion, and the other two patients had an ipsilateral femoral artery occlusion. In addition, four of the six patients had severe symptomatic peripheral vascular disease, and one of the other patients had severe and prolonged perioperative hypoxia. Although all these patients had pure sciatic neuropathy clinically, two of the four patients studied with electromyography had evidence of damage to the femoral nerve or quadriceps muscles ipsilaterally. In addition to the neurogenic changes, there were electromyographic findings suggestive of muscle ischemia. These results indicate that patients undergoing cardiac surgery may be at risk for development of a sciatic neuropathy if they have compromised blood flow through the femoral artery together with another cause for tissue hypoxia. Furthermore, asymptomatic ischemia of the femoral nerve or quadriceps muscles may occur in this clinical setting.