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Rate ePoster

Pain and Spine Medicine

Complex Regional Pain Syndrome (CRPS) in the Bilateral Lower Extremities Immediately after Vascular Surgery: A Case Report

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 4
Has Audio

    Poster Presenter(s)

  • Jennifer Tram, MD

    Medical resident
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Los Angeles, California

    • Co-Author(s)

  • Quynh Giao Pham, MD

    Staff Physiatrist
    Department of Physical Medicine and Rehab (117) West Los Angeles VA Healthcare
    Los Angeles, California

Disclosure(s):
Jennifer Tram, MD: No financial relationships to disclose
Case Diagnosis: Male patient in his 60s diagnosed with complex regional pain syndrome (CRPS) of the lower extremities several months after vascular surgery

Case Description or Program Description: A male patient in his 60s who underwent bilateral femoral endarterectomy and iliac recanalization presented with burning and stabbing pain in the bilateral feet within a few days post-surgery. The symptoms were initially attributed to normal post-surgical course, and he wasn’t seen again until two months later, when the pain had progressed, and he was referred to the Pain clinic where he met Budapest criteria for CRPS. He declined lumbar sympathetic block but agreed to start duloxetine and oxycodone while continuing on gabapentin, alpha-lipoic acid and methocarbamol, previously prescribed for post-surgical pain control by vascular surgery. He was also instructed to perform lower extremity range-of-motion exercises.

Setting: Veterans Administration outpatient pain clinic

Assessment/Results: At follow-up, patient’s pain and sensory symptoms persisted. He was switched to pregabalin, and duloxetine was increased. Home exercise participation was limited due to severe pain. He again refused procedures. Despite ongoing medical management, he reported decreased functionality and quality of life due to leg pain and swelling impairing his ability to walk and drive.

Discussion (relevance): CRPS of bilateral lower extremities after vascular surgery is uncommon. This condition can be confused with ischemic pain, reperfusion injury, surgical wound, infection or other post-surgical complications. Although a pain clinic referral was made after the post-surgical visit and post-operation complications were ruled out, a warm handoff was not done, and urgency of the referral was not communicated. When the patient was seen two months later, pain had progressed and attempts at controlling his condition were ineffective, especially when he refused any further invasive interventions due to fear of procedures.

Conclusions: CRPS of the bilateral lower extremities after vascular surgery is uncommon, but early diagnosis facilitates prompt treatment and may result in better outcomes.