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

Area of Science:

• Pediatric vascular surgery
• Interventional cardiology
• Pediatric critical care

Background:

• Acute limb ischemia is a rare but serious complication in children.
• Iatrogenic vascular trauma during pediatric vascular access can lead to arterial thrombosis.
• Femoral artery injury during femoral venous catheterization is infrequently reported.

Purpose of the Study:

• To report a case of acute limb ischemia in a pediatric patient following inadvertent femoral artery puncture during central venous catheterization.
• To highlight the potential for severe complications even with experienced operators using landmark techniques.
• To emphasize the importance of ultrasound guidance and vigilant postoperative monitoring in pediatric vascular access procedures.

Main Methods:

• Case report of a 13-month-old child who developed acute limb ischemia after femoral central venous catheterization.
• Description of the Seldinger technique used for catheter insertion.
• Diagnosis confirmed by imaging, followed by emergency thrombectomy.

Main Results:

• Successful emergency thrombectomy was performed, resulting in a favorable outcome for the patient.
• The case demonstrates that acute limb ischemia can occur after a single, landmark-guided femoral venous puncture.
• Despite prompt recognition and management, the complication was severe.

Conclusions:

• Routine ultrasound guidance is crucial for pediatric central venous access to minimize iatrogenic arterial injury.
• Vigilant postoperative monitoring is essential for early detection of complications like acute limb ischemia.
• Even experienced operators performing landmark-guided procedures are susceptible to causing significant vascular trauma.