Iatrogenic injury is the most common cause of vascular insufficiency in infants; cardiac catheterization, arteriography and monitoring procedures are often implicated. Loss of limb is rare, but limb shortening is a frequent complication. The diagnosis is usually obvious; pulses are absent, and the extremity is cold, pale or mottled, and spontaneous motion may be absent. Noninvasive studies and digital intravenous angiography are valuable diagnostic techniques. If the limb is viable, systemic heparinization is useful, since it is often best to defer operation until the infant is older and larger if a complex vascular surgical procedure is contemplated. Simple thrombectomy is likely to succeed if immediate surgical treatment is required to ensure viability. A more femoral reconstruction may be performed when the infant is older, but before limb shortening is permanent. Good results have been obtained in as much as 85 per cent of surgically treated patients.