Acute Limb Ischemia in an Infant Following Inadvertent Femoral Arterial Injury During Central Venous Access.

Acute limb ischemia is an uncommon but potentially limb-threatening complication in pediatric patients. Arterial thrombosis secondary to iatrogenic vascular trauma during vascular access procedures in children has been described in the literature, most frequently following catheter-based interventions involving the femoral artery. In contrast, cases arising after inadvertent arterial puncture during femoral venous catheterization are only rarely reported. We describe the case of a 13-month-old child who developed acute ischemia of the right lower limb following accidental femoral artery puncture during a single attempt at femoral central venous catheterization using the landmark technique, performed by a senior operator experienced in pediatric vascular access. A 4-Fr catheter was inserted via the Seldinger technique. Despite initially reassuring procedural indicators and prompt manual compression after the error was recognized, the patient developed clinical signs of acute arterial occlusion. Imaging confirmed the diagnosis, and emergency thrombectomy was successfully performed, resulting in a favorable outcome. This case is particularly instructive because it demonstrates that severe acute limb ischemia may occur after a single landmark-guided femoral venous puncture, even when performed by an experienced operator. It highlights the importance of routine ultrasound guidance for central venous access in pediatric patients, and the need for careful postoperative clinical monitoring to enable early recognition and prompt management of such complications.